Provider Demographics
NPI:1972963163
Name:BURNS, KELLY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 SHANK RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44253-9718
Mailing Address - Country:US
Mailing Address - Phone:330-858-9422
Mailing Address - Fax:
Practice Address - Street 1:8801 SHANK RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44253-9718
Practice Address - Country:US
Practice Address - Phone:330-858-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6988225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist