Healthcare Provider Details

I. General information

NPI: 1144848409
Provider Name (Legal Business Name): KELSY MCMILLION OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FRANKLIN ST
HOLLEY NY
14470-1005
US

IV. Provider business mailing address

7 FRANKLIN ST
HOLLEY NY
14470-1005
US

V. Phone/Fax

Practice location:
  • Phone: 585-754-0664
  • Fax:
Mailing address:
  • Phone: 585-754-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: