MEDICARE: KELLI PRATHER

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	013794	NY
2	225X00000X	Occupational Therapist	OT-006158	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT-006158	OTHER	OH	OCCUPATIONAL THERAPIST
2	013794-1	OTHER	NY	OCCUPATIONAL THERAPIST

General Provider Information

NPI Number	:	1609981984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI PRATHER

Provider Business Mailing Address
First Line	:	PO BOX 141049
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45250-1049
Country	:	US
Telephone Number	:	513-258-9586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 SUMMIT RD STE 105
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2818
Country	:	US
Telephone Number	:	513-258-9586
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/17/2018

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Directions to “ KELLI PRATHER ” Practice Location

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