Provider Demographics
NPI:1396809810
Name:PARTAIN, KELLY YOUNG (OTR,L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:YOUNG
Last Name:PARTAIN
Suffix:
Gender:F
Credentials:OTR,L
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LEE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR,L
Mailing Address - Street 1:6719 GALL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2568
Mailing Address - Country:US
Mailing Address - Phone:813-714-5815
Mailing Address - Fax:813-779-1879
Practice Address - Street 1:6719 GALL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2568
Practice Address - Country:US
Practice Address - Phone:813-714-5815
Practice Address - Fax:813-779-1879
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 6031225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019442800Medicaid
FLZ9537OtherBLUE CROSS BLUE SHIELD