Active NPI
Kimberlyn Nanetta Kelley, OTD, OTR/L
- Occupational Therapist
- Tampa, FL
National Provider Identifier
1336324110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 10652
- Practice address
- 8517 Broken Willow CT
Tampa, FL 33647 - Phone
- (813) 846-9788
- NPI assigned
- Dec 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 10652 | FL | Primary |
Addresses
Primary practice location
8517 Broken Willow CT
Tampa, FL 33647
Mailing address
2916 Habana Way
Tampa, FL 33614-7108
Phone (813) 846-9788
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 |
|---|---|---|---|
| 10652 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427760000000",
"number": "1336324110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2916 HABANA WAY",
"city": "TAMPA",
"state": "FL",
"postal_code": "336147108",
"telephone_number": "813-846-9788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8517 BROKEN WILLOW CT",
"city": "TAMPA",
"state": "FL",
"postal_code": "33647",
"telephone_number": "813-846-9788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "KIMBERLYN",
"middle_name": "NANETTA",
"credential": "OTD, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-30",
"last_updated": "2015-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "10652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.