Healthcare Provider Details

I. General information

NPI: 1790905453
Provider Name (Legal Business Name): KELLY VERZWYVELT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 HWY 317
CENTERVILLE LA
70522
US

IV. Provider business mailing address

305 MAIN ST
FRANKLIN LA
70538-6120
US

V. Phone/Fax

Practice location:
  • Phone: 985-290-2179
  • Fax:
Mailing address:
  • Phone: 985-290-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: