Provider Demographics
NPI:1528932258
Name:JENNINGS, KELCIE J (OT, OTD)
Entity type:Individual
Prefix:
First Name:KELCIE
Middle Name:J
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OT, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 1ST ST APT 325
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-5741
Mailing Address - Country:US
Mailing Address - Phone:435-851-4127
Mailing Address - Fax:
Practice Address - Street 1:4201 SPRING VALLEY RD STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-1209
Practice Address - Country:US
Practice Address - Phone:866-919-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125935225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics