Healthcare Provider Details

I. General information

NPI: 1043255011
Provider Name (Legal Business Name): KELLY N KEY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HOSPITAL DR SUITE 120
BOSSIER CITY LA
71111-2167
US

IV. Provider business mailing address

2820 HEARNE AVE
SHREVEPORT LA
71103-3934
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-1760
  • Fax: 318-742-8839
Mailing address:
  • Phone: 318-631-7999
  • Fax: 318-631-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ11062
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberZ110662
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: