Active NPI
Jay Kelly, OTL
- Occupational Therapist
- Eden, NC
National Provider Identifier
1235685108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3129
- Practice address
- 205 E Kings Hwy
Eden, NC 27288-5239 - Phone
- (336) 623-9712
- NPI assigned
- Aug 30, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3129 | NC | Primary |
Addresses
Primary practice location
205 E Kings Hwy
Eden, NC 27288-5239
Mailing address
4401 Brecon LN
Greensboro, NC 27407-6158
Phone (910) 620-5672
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3129 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472515200000",
"number": "1235685108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 BRECON LN",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274076158",
"telephone_number": "910-620-5672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 E KINGS HWY",
"city": "EDEN",
"state": "NC",
"postal_code": "272885239",
"telephone_number": "336-623-9712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JAY",
"name_prefix": "Mr.",
"credential": "OTL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-30",
"last_updated": "2016-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "3129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.