Provider Demographics
NPI:1942448287
Name:MITCHELL, KELLIE DENISE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:DENISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16900 W CALLE CARMELA
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-9215
Mailing Address - Country:US
Mailing Address - Phone:520-682-6153
Mailing Address - Fax:
Practice Address - Street 1:16900 W CALLE CARMELA
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9215
Practice Address - Country:US
Practice Address - Phone:520-682-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1726224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant