Provider Demographics
NPI:1760756688
Name:TOLLEY, KELLYE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:KELLYE
Other - Middle Name:
Other - Last Name:LINGERFELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 JOHNNIE DODDS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3100
Mailing Address - Country:US
Mailing Address - Phone:843-568-4786
Mailing Address - Fax:888-965-4405
Practice Address - Street 1:1051 JOHNNIE DODDS BLVD STE G
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-568-4786
Practice Address - Fax:888-965-4405
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3907225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist