Healthcare Provider Details

I. General information

NPI: 1831317759
Provider Name (Legal Business Name): KELLY KAY O'DONNELL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PARK ST
BELLEVUE IA
52031-1911
US

IV. Provider business mailing address

38529 HWY 52
BELLEVUE IA
52031
US

V. Phone/Fax

Practice location:
  • Phone: 563-872-5521
  • Fax:
Mailing address:
  • Phone: 563-773-2628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00662
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: