Kelley Price
Individual provider Active NPI Occupational Therapy Assistant · Shady Spring, WV
NPI 1003522210 · NPPES record last updated Jan 31, 2023
Key facts
- NPI
- 1003522210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- C2290 (WV)
- Practice address
- 145 Shady Lake Dr
Shady Spring, WV 25918-8461 - Phone
- (304) 578-0008
- NPI assigned
- Jan 31, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C2290 | WV | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | C2290 | WV | Yes |
Addresses
Primary practice location
145 Shady Lake Dr
Shady Spring, WV 25918-8461
Mailing address
145 Shady Lake Dr
Shady Spring, WV 25918-8461
Phone (304) 578-0008
NPI Registry JSON
{
"created_epoch": "1675123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1003522210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 SHADY LAKE DR",
"city": "SHADY SPRING",
"state": "WV",
"postal_code": "259188461",
"telephone_number": "304-578-0008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 SHADY LAKE DR",
"city": "SHADY SPRING",
"state": "WV",
"postal_code": "259188461",
"telephone_number": "304-578-0008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRICE",
"first_name": "KELLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-31",
"last_updated": "2023-01-31",
"certification_date": "2023-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WV",
"license": "C2290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shady Spring, WV
- Dreama Kaye Pauley
- Allyson Perez
- Angela Persinger
- Keira Elizabeth Pinardo
- Kelly McCoy Pitsenbarger
- Karen D Richmond
- Cindy Kaye Robbins
- Bill Short
- James D Short
- Carolyn Sinclair
All providers in Shady Spring, WV · Occupational Therapy Assistant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.