Healthcare Provider Details

I. General information

NPI: 1043882053
Provider Name (Legal Business Name): KELSEY OBANDO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 SW 146TH CT
MIAMI FL
33183-2938
US

IV. Provider business mailing address

7735 SW 146TH CT
MIAMI FL
33183-2938
US

V. Phone/Fax

Practice location:
  • Phone: 305-764-9071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: