Healthcare Provider Details

I. General information

NPI: 1164319448
Provider Name (Legal Business Name): KELSEY NICOLE MILLS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 QUIET OAK LN
HUNTINGTON WV
25702-2042
US

IV. Provider business mailing address

256 QUIET OAK LN
HUNTINGTON WV
25702-2042
US

V. Phone/Fax

Practice location:
  • Phone: 304-634-7033
  • Fax:
Mailing address:
  • Phone: 304-634-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1971
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: