Provider Demographics
NPI:1396121802
Name:BLEDSOE, KELLI ELLIOTT (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ELLIOTT
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5576 KANE GAP RD
Mailing Address - Street 2:
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244-8084
Mailing Address - Country:US
Mailing Address - Phone:276-393-9747
Mailing Address - Fax:
Practice Address - Street 1:5576 KANE GAP RD
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-8084
Practice Address - Country:US
Practice Address - Phone:276-393-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist