MEDICARE: KELLI DENISE MINGA OTA

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	224Z00000X	Occupational Therapy Assistant	2110	TN

General Provider Information

NPI Number	:	1548104896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI DENISE MINGA OTA

Provider Business Mailing Address
First Line	:	117 ELIZABETHTON WAY
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-4032
Country	:	US
Telephone Number	:	865-314-0005
Fax Number	:	865-332-1900

Provider Business Practice Location Address
First Line	:	117 ELIZABETHTON WAY
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-4032
Country	:	US
Telephone Number	:	865-314-0005
Fax Number	:	865-332-1900

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ KELLI DENISE MINGA OTA” Practice Location

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