Provider Demographics
NPI:1295748945
Name:ANDERSON, KELLI A
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-212-9435
Mailing Address - Fax:205-212-3299
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-212-9435
Practice Address - Fax:205-212-3299
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630648108469PTOtherVIVA
AL051535137OtherBCBS OF AL
AL60640OtherBCBS OF AL
AL60640OtherBCBS OF AL
AL051535137OtherBCBS OF AL