Healthcare Provider Details

I. General information

NPI: 1164554408
Provider Name (Legal Business Name): CATHLEEN JOYCE KELLY OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 WASHINGTON ST
CLYDE KS
66938
US

IV. Provider business mailing address

PO BOX 35
SCOTT CITY KS
67871-0035
US

V. Phone/Fax

Practice location:
  • Phone: 785-738-0321
  • Fax:
Mailing address:
  • Phone: 785-738-0321
  • Fax: 785-738-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-01970
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: