Kelby Renee Nicholson, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OT-A1668 Issued in AR

Practice address

610 N Missouri St Ste 1
West Memphis, AR 72301-3148

Phone

(870) 400-0179

Fax

(870) 400-0479

NPI assigned

Nov 19, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therapeutic Focus, L.L.C.

  • Occupational Therapist
  • West Memphis, AR
  • NPI 1972875896

  Occupational Therapy Assistant

  NPD
• Therapeutic Alliance

  • Orthopedic Physical Therapist
  • West Memphis, AR
  • NPI 1003219510

  Occupational Therapy Assistant

  NPD (past)

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1174126338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N MISSOURI ST STE 1",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013148",
            "telephone_number": "870-400-0179",
            "fax_number": "870-400-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N MISSOURI ST STE 1",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013148",
            "telephone_number": "870-400-0179",
            "fax_number": "870-400-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "KELBY",
        "middle_name": "RENEE",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A1668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel J. Nelson, LPC
• Savannah Neri, PTA
• Decrecia Nevels, COTA/L
• Bryce Newsome
• Emily Nichols, OTD, OTR/L
• Grace Norcross Niclosi
• Northeast Arkansas Community Mental Health Center
• Northeast Arkansas Community Mental Health Center Inc
• Northeast Arkansas Community Mental Health Center Inc
• Victoria Ruth Norton, P.T.A.

• All providers in West Memphis, AR
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.