Provider Demographics
NPI:1295908531
Name:TUZZIO, KELLY L (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:TUZZIO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:413 LAUREL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8407
Mailing Address - Country:US
Mailing Address - Phone:614-580-2128
Mailing Address - Fax:
Practice Address - Street 1:3690 N MOUNT JULIET RD
Practice Address - Street 2:STE 400
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3181
Practice Address - Country:US
Practice Address - Phone:615-758-4888
Practice Address - Fax:615-758-6188
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT00000005098225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094740Medicaid