Individual
CHANDLER T KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR, OTD
Contact information
Practice address
11751 ALTA VISTA RD STE 201, FORT WORTH, TX 76244-6442
(817) 562-1006
(817) 562-1009
Mailing address
11751 ALTA VISTA RD STE 201, FORT WORTH, TX 76244-6442
(817) 562-1006
(817) 562-1009
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-20-114824
IN
225X00000X
Occupational Therapist
Primary
125011
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125011
OCCUPATIONAL THERAPY TEXAS STATE LICENSE
TX
01
—
517461
OT NATIONAL LICENSE ISSUED BY NBCOT
—
Enumeration date
04/02/2020
Last updated
09/23/2024
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