Provider Demographics
NPI:1801960026
Name:KELLY, RICHARD R (OT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:R
Last Name:KELLY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:966 N GARDEN RIDGE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:972-436-2770
Practice Address - Street 1:966 N GARDEN RIDGE
Practice Address - Street 2:SUITE 530
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:972-420-6605
Practice Address - Fax:972-436-2770
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX800T24Medicare PIN