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General NPI Number Information
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NPI Number | 1124335401
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Entity Type | Individual
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Provider Name | KELLI L. FETTER OT
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Gender | Female
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 1900 MIDLAND TRAIL STE 1 & 2
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City | SHELBYVILLE
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State | KY
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Zip | 40065
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Country | US
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Telephone | 502-633-1007
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Fax | 502-437-0624
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Provider Business Mailing Address
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Address Line | 8500 WOLF PEN BRANCH RD
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City | PROSPECT
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State | KY
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Zip | 40059-8622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | R4583
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License Number State | KY
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