Provider Demographics
NPI:1255908315
Name:PHELPS, KARI LYNNE (BACHELOR'S)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LYNNE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:BACHELOR'S
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:LYNNE
Other - Last Name:KELTERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELOR'S OF SCIENC
Mailing Address - Street 1:4701 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-3066
Mailing Address - Country:US
Mailing Address - Phone:562-857-8780
Mailing Address - Fax:
Practice Address - Street 1:1525 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-4601
Practice Address - Country:US
Practice Address - Phone:562-857-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist