Provider Demographics
NPI:1962758227
Name:LOUVIERE, KELLY (OT/R)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LOUVIERE
Suffix:
Gender:F
Credentials:OT/R
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RENE'E
Other - Last Name:LAVERGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3312 NW WILLOW CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957
Mailing Address - Country:US
Mailing Address - Phone:321-289-9955
Mailing Address - Fax:
Practice Address - Street 1:3312 NW WILLOW CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3044
Practice Address - Country:US
Practice Address - Phone:321-289-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist