Provider Demographics
NPI:1760514608
Name:FISCHELS, KELLEY RENEE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:RENEE
Last Name:FISCHELS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 JAMESTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9848
Mailing Address - Country:US
Mailing Address - Phone:319-334-7140
Mailing Address - Fax:
Practice Address - Street 1:2300 SWAN LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9707
Practice Address - Country:US
Practice Address - Phone:319-334-5155
Practice Address - Fax:319-334-6166
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37309OtherWELLMARK
IAI19172064Medicare PIN
IAI19172Medicare PIN
IAIB1212Medicare PIN
IAIB1213032Medicare PIN
IA37309OtherWELLMARK
IAIB1213Medicare PIN