Provider Demographics
NPI:1669729752
Name:REED, KELLY ANN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:MOENING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1310 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4061
Mailing Address - Country:US
Mailing Address - Phone:651-260-8804
Mailing Address - Fax:
Practice Address - Street 1:1310 2ND ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4061
Practice Address - Country:US
Practice Address - Phone:651-260-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101002225X00000X
WI612-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist