Provider Demographics
NPI:1801487954
Name:REESE, KELLY NICOLE (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:NICOLE
Last Name:REESE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 E QUIET HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6226
Mailing Address - Country:US
Mailing Address - Phone:262-894-9876
Mailing Address - Fax:
Practice Address - Street 1:7325 E PRINCESS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5991
Practice Address - Country:US
Practice Address - Phone:262-894-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist