Provider Demographics
NPI:1023584844
Name:GARRETT, KELSEY E (COTA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:GARRETT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77879-4519
Mailing Address - Country:US
Mailing Address - Phone:575-791-7867
Mailing Address - Fax:
Practice Address - Street 1:1115 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4465
Practice Address - Country:US
Practice Address - Phone:979-693-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215347224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant