Provider Demographics
NPI:1316123805
Name:GUILLORY, KELLY KAY (OTR)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KAY
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:HODGKINSON
Other - Last Name:GUILLORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:8717 S DANA
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-8229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 N CENTRAL EXPY STE 110
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2718
Practice Address - Country:US
Practice Address - Phone:214-265-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108182225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics