Provider Demographics
NPI:1528473279
Name:MCKELVY, BRANDY LEIGH (COTA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEIGH
Last Name:MCKELVY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LEIGH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 BALSAM LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-7816
Mailing Address - Country:US
Mailing Address - Phone:972-571-8916
Mailing Address - Fax:
Practice Address - Street 1:9400 N CENTRAL EXPY STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5027
Practice Address - Country:US
Practice Address - Phone:972-581-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant