Provider Demographics
NPI:1598297848
Name:STILL, KELLI (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:STILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PEBBLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6626
Mailing Address - Country:US
Mailing Address - Phone:843-367-3699
Mailing Address - Fax:
Practice Address - Street 1:10 FOUNTAINVIEW TER
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4060
Practice Address - Country:US
Practice Address - Phone:864-501-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist