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General NPI Number Information
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NPI Number | 1275665234
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Entity Type | Individual
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Provider Name | KELLY ANN CLANCY OTRL, CHT, RBT
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/12/2009
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Provider Practice Location Address
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Address Line | 2821 NW MARKET ST STE E
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City | SEATTLE
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State | WA
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Zip | 98107-5815
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Country | US
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Telephone | 206-508-1265
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Fax | 206-508-1265
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Provider Business Mailing Address
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Address Line | 3323 NW 71ST ST
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City | SEATTLE
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State | WA
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Zip | 98117-6146
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Country | US
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Telephone | 206-508-1265
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Fax | 206-508-1265
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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 | OT00001887
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License Number State | WA
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