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General NPI Number Information
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NPI Number | 1467910919
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Entity Type | Individual
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Provider Name | KELLIE LORRAINE BEALL OT
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Gender | Female
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1825 FORTVIEW RD STE 103
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City | AUSTIN
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State | TX
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Zip | 78704-7654
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Country | US
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Telephone | 512-444-4263
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Fax | 512-444-4262
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Provider Business Mailing Address
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Address Line | PO BOX 226656
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City | DALLAS
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State | TX
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Zip | 75222-6656
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Country | US
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Telephone | 214-943-9431
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Fax | 214-943-9407
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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 | 119807
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License Number State | TX
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