Kellie Love Willis, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA14701 Issued in FL

Practice address

3492 Martin Hurst Rd
Tallahassee, FL 32312-1702

Phone

(850) 294-9716

NPI assigned

Dec 16, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Kellie Love Willis Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1144868555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12495 HOLEY RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323179607",
            "telephone_number": "850-322-8219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3492 MARTIN HURST RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323121702",
            "telephone_number": "850-294-9716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KELLIE",
        "middle_name": "LOVE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA14701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lorimccoy@lorimccoytherapy.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3492 Martin Hurst Rd",
            "city": "Tallahassee",
            "state": "FL",
            "country_code": "US",
            "postal_code": "323121702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "WILLIS",
            "middle_name": "LOVE",
            "prefix": "MRS.",
            "credential": "COTA/L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Victoria D Williams, RBT
• Willie Lewis Williams, MSW
• Annie Catherine Willis, COTA/L
• Brandy C. Willis, M.D.
• Jason Paul Willis
• Kendall Willis, FNP
• Mary Caitlin Willis, RN
• Ronald Gordan Willis Jr., DMD
• Steven Mathias Willis, DC
• Sydney Nicole Willis

• Occupational Therapy Assistant in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Occupational Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; 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.