Provider Demographics
NPI:1659575033
Name:KELLY, KIMBERLEE LYN (OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:LYN
Last Name:KELLY
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 1:33860 N SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3534
Mailing Address - Country:US
Mailing Address - Phone:202-607-9337
Mailing Address - Fax:
Practice Address - Street 1:33860 N SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-3534
Practice Address - Country:US
Practice Address - Phone:202-607-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-005731225X00000X
MD05463225X00000X
NV16-0683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist