Provider Demographics
NPI:1760766612
Name:COLLINS, KELLY DENISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DENISE
Other - Last Name:AIRHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1136 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-5335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1136 2ND ST
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-5335
Practice Address - Country:US
Practice Address - Phone:310-376-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3864225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics