Healthcare Provider Details

I. General information

NPI: 1659297067
Provider Name (Legal Business Name): KELSEY LAWRENCE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 VICTORY BLVD STE 100
NORTH HOLLYWOOD CA
91606-3513
US

IV. Provider business mailing address

11633 VICTORY BLVD STE 100
NORTH HOLLYWOOD CA
91606-3513
US

V. Phone/Fax

Practice location:
  • Phone: 818-835-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: