Provider Demographics
NPI:1841412327
Name:MCCREA, KELLEY L (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:L
Last Name:MCCREA
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5151 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6658
Mailing Address - Country:US
Mailing Address - Phone:801-161-3321
Mailing Address - Fax:801-261-5942
Practice Address - Street 1:5151 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6658
Practice Address - Country:US
Practice Address - Phone:801-161-3321
Practice Address - Fax:801-261-5942
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist