MEDICARE: BRIA KELLAR OTR/L

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	OT006365	GA

General Provider Information

NPI Number	:	1619334422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIA KELLAR OTR/L

Provider Business Mailing Address
First Line	:	9315 SKITTS MOUNTAIN DR
Second Line	:
City	:	LULA
State	:	GA
Zip	:	30554-2121
Country	:	US
Telephone Number	:	770-540-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	5226 DAHLONEGA HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-1946
Country	:	US
Telephone Number	:	770-540-4803
Fax Number	:

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

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	06/23/2017

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