Provider Demographics
NPI:1598801763
Name:PITMAN, KELLI ANNE (OTRL)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANNE
Last Name:PITMAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:GASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3446 SOURWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7890
Mailing Address - Country:US
Mailing Address - Phone:828-514-2064
Mailing Address - Fax:
Practice Address - Street 1:103 DORSETT DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2278
Practice Address - Country:US
Practice Address - Phone:704-636-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6283225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist