Provider Demographics
NPI:1922490713
Name:WETHERBEE, KELLY A (OTR/L, DMI, SWC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:WETHERBEE
Suffix:
Gender:F
Credentials:OTR/L, DMI, SWC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:LEALOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, SWC
Mailing Address - Street 1:4144 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020
Mailing Address - Country:US
Mailing Address - Phone:323-459-3055
Mailing Address - Fax:661-254-1862
Practice Address - Street 1:4144 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020
Practice Address - Country:US
Practice Address - Phone:323-459-3055
Practice Address - Fax:661-254-1862
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTR 6869225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics