Provider Demographics
NPI:1396257291
Name:RICCI, KELLY (OT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RICCI
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 1:27306 BALSON FOREST LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4257
Mailing Address - Country:US
Mailing Address - Phone:860-680-2676
Mailing Address - Fax:
Practice Address - Street 1:27306 BALSON FOREST LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4257
Practice Address - Country:US
Practice Address - Phone:860-680-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115493225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist