Provider Demographics
NPI:1992317499
Name:ADAIR, KELLY MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:ADAIR
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 CAMDEN LAKE PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8076
Mailing Address - Country:US
Mailing Address - Phone:502-593-5912
Mailing Address - Fax:
Practice Address - Street 1:5250 CAMDEN LAKE PKWY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8076
Practice Address - Country:US
Practice Address - Phone:502-593-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007772225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics