Healthcare Provider Details

I. General information

NPI: 1568864585
Provider Name (Legal Business Name): KELLY CHAMBERS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 E 79TH ST
CLEVELAND OH
44103-2864
US

IV. Provider business mailing address

4625 STATE ROUTE 305
SOUTHINGTON OH
44470-9768
US

V. Phone/Fax

Practice location:
  • Phone: 216-838-1961
  • Fax:
Mailing address:
  • Phone: 330-984-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number323934
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT012263
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: