MEDICARE: KELLI EASLEY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	112291	TX

General Provider Information

NPI Number	:	1255663464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI EASLEY OTR

Provider Business Mailing Address
First Line	:	716 INDIAN TRL STE 140
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5702
Country	:	US
Telephone Number	:	254-213-2952
Fax Number	:	254-213-2952

Provider Business Practice Location Address
First Line	:	716 INDIAN TRL STE 140
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5702
Country	:	US
Telephone Number	:	254-213-2952
Fax Number	:	254-213-2952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	09/15/2023

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Directions to “ KELLI EASLEY OTR” Practice Location

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