Provider Demographics
NPI:1831317759
Name:O'DONNELL, KELLY KAY (OTR)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAY
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38529 HWY 52
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031
Mailing Address - Country:US
Mailing Address - Phone:563-773-2628
Mailing Address - Fax:
Practice Address - Street 1:1201 PARK ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031-1911
Practice Address - Country:US
Practice Address - Phone:563-872-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist