Provider Demographics
NPI:1710009717
Name:STINNETT, KELLY ANN I
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:STINNETT
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:LEONARD
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 BRIGHTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3643
Mailing Address - Country:US
Mailing Address - Phone:410-832-2398
Mailing Address - Fax:410-321-4936
Practice Address - Street 1:19 SOFTWINDS CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1373
Practice Address - Country:US
Practice Address - Phone:410-356-0944
Practice Address - Fax:410-356-0944
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist