Provider Demographics
NPI:1790810414
Name:RAWN, KELLI KOTLARZ (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:KOTLARZ
Last Name:RAWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:KOTLARZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:6720 WAVERLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207
Mailing Address - Country:US
Mailing Address - Phone:501-944-3420
Mailing Address - Fax:
Practice Address - Street 1:2400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-982-4578
Practice Address - Fax:501-533-6326
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1972225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156333721Medicaid