Healthcare Provider Details

I. General information

NPI: 1275665234
Provider Name (Legal Business Name): KELLY ANN CLANCY OTRL, CHT, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 NW MARKET ST STE E
SEATTLE WA
98107-5815
US

IV. Provider business mailing address

3323 NW 71ST ST
SEATTLE WA
98117-6146
US

V. Phone/Fax

Practice location:
  • Phone: 206-508-1265
  • Fax: 206-508-1265
Mailing address:
  • Phone: 206-508-1265
  • Fax: 206-508-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00001887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: