Provider Demographics
NPI:1386959971
Name:FLEMING, KELLY L (OT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:FLEMING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 NORTH LAKE SHORE DRIVE
Mailing Address - Street 2:SUITE 924
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8701
Mailing Address - Country:US
Mailing Address - Phone:312-475-5628
Mailing Address - Fax:866-954-5796
Practice Address - Street 1:680 NORTH LAKE SHORE DRIVE
Practice Address - Street 2:SUITE 924
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8701
Practice Address - Country:US
Practice Address - Phone:312-475-5628
Practice Address - Fax:866-954-5796
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-007709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist