Provider Demographics
NPI:1689068678
Name:HACKETT, KELSEY PAIGE (OTR, MOT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:PAIGE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:PAIGE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, MOT
Mailing Address - Street 1:1101 CENTRAL EXPY S
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8131
Mailing Address - Country:US
Mailing Address - Phone:214-509-6961
Mailing Address - Fax:
Practice Address - Street 1:1101 CENTRAL EXPY S
Practice Address - Street 2:SUITE 185
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8131
Practice Address - Country:US
Practice Address - Phone:214-509-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116725225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics