Provider Demographics
NPI:1598019614
Name:TEJADA, KELSEY (COTA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TEJADA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:RATCLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3801 MAIN DR STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6364
Mailing Address - Country:US
Mailing Address - Phone:479-856-6400
Mailing Address - Fax:479-856-6623
Practice Address - Street 1:2837 AMERICAN ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6927
Practice Address - Country:US
Practice Address - Phone:479-365-7258
Practice Address - Fax:479-365-7248
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A705224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant