MEDICARE: KELLY PARKER MOT, OTR

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	114674	TX
2	225X00000X	Occupational Therapist	OT18574	FL

General Provider Information

NPI Number	:	1942547427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY PARKER MOT, OTR

Provider Business Mailing Address
First Line	:	2002 HOLCOMBE BLVD
Second Line	:	SUITE 2B-301
City	:	HOUSTON
State	:	TX
Zip	:	77030-4211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6202 17TH AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-7838
Country	:	US
Telephone Number	:	941-792-1404
Fax Number	:

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	05/19/2023

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