MEDICARE: KELLIE LORRAINE BEALL OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	119807	TX

General Provider Information

NPI Number	:	1467910919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE LORRAINE BEALL OT

Provider Business Mailing Address
First Line	:	PO BOX 226656
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-6656
Country	:	US
Telephone Number	:	214-943-9431
Fax Number	:	214-943-9407

Provider Business Practice Location Address
First Line	:	1825 FORTVIEW RD STE 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7654
Country	:	US
Telephone Number	:	512-444-4263
Fax Number	:	512-444-4262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	05/21/2025

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