Provider Demographics
NPI:1013254408
Name:MEENTS, KELLI RENEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RENEE
Last Name:MEENTS
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 1:2805 BLAIR DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3558
Mailing Address - Country:US
Mailing Address - Phone:217-377-9329
Mailing Address - Fax:
Practice Address - Street 1:2805 BLAIR DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3558
Practice Address - Country:US
Practice Address - Phone:217-377-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.001808224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant