Healthcare Provider Details

I. General information

NPI: 1356764138
Provider Name (Legal Business Name): KELSEY LAUREN W. SINCLAIR MOT, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 MIDWAY RD SUITE 107
DALLAS TX
75244-4313
US

IV. Provider business mailing address

13720 MIDWAY RD SUITE 107
DALLAS TX
75244-4313
US

V. Phone/Fax

Practice location:
  • Phone: 214-646-1449
  • Fax: 214-516-7979
Mailing address:
  • Phone: 214-646-1449
  • Fax: 214-516-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number305226
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number115905
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: