Provider Demographics
NPI:1972968253
Name:KELLY, OLIVIA GRIFFITH
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRIFFITH
Last Name:KELLY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FARM LN
Mailing Address - Street 2:
Mailing Address - City:SPERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22740-2185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 FARM LN
Practice Address - Street 2:
Practice Address - City:SPERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22740-2185
Practice Address - Country:US
Practice Address - Phone:256-996-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008487225X00000X
TN4867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist