Individual
MRS. MARY JO KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1191 BELLAMY TIPTON RD, GATE CITY, VA 24251-5046
(239) 292-7489
Mailing address
1191 BELLAMY TIPTON RD, GATE CITY, VA 24251-5046
(239) 292-7489
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119007492
VA
225X00000X
Occupational Therapist
5809
FL
225X00000X
Occupational Therapist
OT0000004939
TN
225XP0019X
Physical Rehabilitation Occupational Therapist
OT0000004939
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119007492
STATE OT LICENSE
VA
01
—
134421797
DRIVERS LICENSE
TN
01
—
OT0000004939
STATE LICENSE OT
TN
Enumeration date
03/26/2018
Last updated
05/22/2023
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