Provider Demographics
NPI:1942547427
Name:PARKER, KELLY (MOT, OTR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:KELLYU
Other - Middle Name:
Other - Last Name:VERNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:SUITE 2B-301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6202 17TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7838
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114674225X00000X
FLOT18574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist