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General NPI Number Information
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NPI Number | 1437464450
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Entity Type | Individual
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Provider Name | KELLI D NITSCH MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 306 E 11TH ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-6156
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Country | US
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Telephone | 479-968-1198
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Fax | 479-967-1178
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Provider Business Mailing Address
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Address Line | 4707 DEXTER AVE
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City | FORT WORTH
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State | TX
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Zip | 76107-3737
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Country | US
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Telephone | 479-857-6637
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Fax | 479-967-1178
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | O-T1039
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License Number State | AR
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