Kimi Marie Kelly, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

383026 Issued in WI

Practice address

2661 S Broadway
Green Bay, WI 54304-5305

Phone

(920) 592-5262

NPI assigned

Jan 31, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kimi Marie Hanson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Fox Rehabilitation Services Wi LLC

  • Physical Therapist
  • Milwaukee, WI
  • NPI 1518483973

  Occupational Therapist

  NPD
• Phyt Rehab of Wisconsin, Inc.

  • Physical Therapist
  • Wausau, WI
  • NPI 1366965931
  NPD

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1346428414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2757 NICOLET DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543117219",
            "telephone_number": "920-391-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2661 S BROADWAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045305",
            "telephone_number": "920-592-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KIMI",
        "middle_name": "MARIE",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-31",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "838-26",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "383026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMI",
            "last_name": "HANSON",
            "middle_name": "MARIE",
            "credential": "OT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jeffery W Keller, MD
• Kelsy B Kellermann, PA
• Miriah Kelley, RN
• Sharon A Kelley, PTA
• Jenny Lynn Kelly, APNP
• Peggy Sue Kelsall
• Camille Ann Kemper, LCSW
• Ken Sann
• Kimberly Kendall, PT
• Kayce Kendziorski

• Occupational Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.