Provider Demographics
NPI:1881975647
Name:ANDERSON, KELLY REBECCA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:REBECCA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WREN CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-7859
Mailing Address - Country:US
Mailing Address - Phone:864-640-9331
Mailing Address - Fax:
Practice Address - Street 1:2383 HIGHWAY 41
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-2447
Practice Address - Country:US
Practice Address - Phone:843-556-1070
Practice Address - Fax:843-556-6742
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist