Provider Demographics
NPI:1740645415
Name:WHITNEY, KELSEY (COTA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:146 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4077
Mailing Address - Country:US
Mailing Address - Phone:870-520-8761
Mailing Address - Fax:
Practice Address - Street 1:146 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4077
Practice Address - Country:US
Practice Address - Phone:870-520-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2015-043224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant