Provider Demographics
NPI:1700103728
Name:KELLEY, HOLLIE DESLATTE (OTR/L, PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:DESLATTE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:OTR/L, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 CHRIS XING
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485-4806
Mailing Address - Country:US
Mailing Address - Phone:225-485-7876
Mailing Address - Fax:
Practice Address - Street 1:1022 CHRIS XING
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485-4806
Practice Address - Country:US
Practice Address - Phone:225-485-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200366225X00000X
LA07767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist