Provider Demographics
NPI:1902373996
Name:FLYNN, KELLEE D (COTA)
Entity Type:Individual
Prefix:
First Name:KELLEE
Middle Name:D
Last Name:FLYNN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KELLEE
Other - Middle Name:D
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:11281 HIGHWAY U
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-6269
Mailing Address - Country:US
Mailing Address - Phone:806-673-0000
Mailing Address - Fax:
Practice Address - Street 1:11281 HIGHWAY U
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-6269
Practice Address - Country:US
Practice Address - Phone:806-673-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010031975224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant