Provider Demographics
NPI:1740450436
Name:OTT, KELLI RHEA (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RHEA
Last Name:OTT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-0624
Mailing Address - Country:US
Mailing Address - Phone:937-308-5055
Mailing Address - Fax:
Practice Address - Street 1:3768 WAYNE TRACE RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8412
Practice Address - Country:US
Practice Address - Phone:937-308-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI08000661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical