Provider Demographics
NPI:1922593557
Name:KELLAR, AMELIA LEE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:LEE
Last Name:KELLAR
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2771
Mailing Address - Country:US
Mailing Address - Phone:904-644-1974
Mailing Address - Fax:
Practice Address - Street 1:50 EXECUTIVE WAY
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-2771
Practice Address - Country:US
Practice Address - Phone:904-644-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133246225X00000X
FLOT21620225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist