NPIMap

Individual provider Active NPI

Kelly Russo Stone, OTR/L

  • Pediatric Occupational Therapist
  • Mandeville, LA
National Provider Identifier
1104053529
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OTT.Z1156 Issued in LA
Practice address
505 Louvois St
Mandeville, LA 70448-5468
Phone
(678) 462-2923
Fax
(866) 753-4652
NPI assigned
Jun 11, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Environmental Modification Occupational Therapist 225XE0001X OTT.Z1156 LA
Feeding, Eating & Swallowing Occupational Therapist 225XF0002X OTT.Z1156 LA
Mental Health Occupational Therapist 225XM0800X OTT.Z1156 LA
Neurorehabilitation Occupational Therapist 225XN1300X OTT.Z1156 LA
Pediatric Occupational Therapist 225XP0200X OTT.Z1156 LA Primary

Addresses

Primary practice location

505 Louvois St
Mandeville, LA 70448-5468

Mailing address

505 Louvois St
Mandeville, LA 70448-5468
Phone (678) 462-2923

Other identifiers 1

IdentifierTypeStateIssuer
2450514MedicaidLA

Other names 1

  • Miss Kelly Ann Russo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OTT.Z1156LAMDFeeding, Eating & Swallowing Occupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1104053529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 LOUVOIS ST",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704485468",
            "telephone_number": "678-462-2923",
            "fax_number": "866-753-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 LOUVOIS ST",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704485468",
            "telephone_number": "678-462-2923",
            "fax_number": "866-753-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STONE",
        "first_name": "KELLY",
        "middle_name": "RUSSO",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-11",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XE0001X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": "LA",
            "license": "OTT.Z1156",
            "primary": false
        },
        {
            "code": "225XF0002X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": "LA",
            "license": "OTT.Z1156",
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Mental Health",
            "state": "LA",
            "license": "OTT.Z1156",
            "primary": false
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "LA",
            "license": "OTT.Z1156",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "LA",
            "license": "OTT.Z1156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2450514",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "RUSSO",
            "middle_name": "ANN",
            "prefix": "MISS",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.