Provider Demographics
NPI:1881003523
Name:BARRETT, KELLY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7116
Mailing Address - Country:US
Mailing Address - Phone:336-688-6519
Mailing Address - Fax:
Practice Address - Street 1:101 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2431
Practice Address - Country:US
Practice Address - Phone:336-688-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7085225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics