Provider Demographics
NPI:1902205313
Name:ARMSTEAD, KELLY PARKER (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:PARKER
Last Name:ARMSTEAD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:GRACE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:8720 SCENIC HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514
Mailing Address - Country:US
Mailing Address - Phone:334-488-4711
Mailing Address - Fax:
Practice Address - Street 1:6108 VILLAGE OAKS DR STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6907
Practice Address - Country:US
Practice Address - Phone:334-488-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3580225X00000X
FLOT15182225X00000X
FLOT 15182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist