Provider Demographics
NPI:1700317450
Name:WINTERS, KELLY K (MS, CRC, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:K
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MS, CRC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 SOUTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-1314
Mailing Address - Country:US
Mailing Address - Phone:307-277-9669
Mailing Address - Fax:
Practice Address - Street 1:8146 SOUTHWOOD ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-1314
Practice Address - Country:US
Practice Address - Phone:307-277-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator