Kelly McCollum, MSOTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT1754 Issued in OK

Practice address

7506 Covington Hollow LN
Fort Wayne, IN 46804-6152

Phone

(405) 919-8142

NPI assigned

Apr 4, 2017

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

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": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600560000000",
    "number": "1447783816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7506 COVINGTON HOLLOW LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046152",
            "telephone_number": "405-919-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7506 COVINGTON HOLLOW LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046152",
            "telephone_number": "405-919-8142"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "124 E Sheridan Ave",
            "address_purpose": "LOCATION",
            "city": "Kingfisher",
            "state": "OK",
            "postal_code": "737503217",
            "country_code": "US",
            "telephone_number": "405-919-8142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "KELLY",
        "credential": "MSOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-04",
        "last_updated": "2020-09-20",
        "certification_date": "2020-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "OK",
            "license": "OT1754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison McClellan, DPT
• Colleen Marie McClurg, MS LMHC
• Dee W McClurg, LSW
• Crystal Lynn McCollister, LMHCA
• Joseph William McCollom, DO
• Angela McComas, BCBA
• Paul David McComas, BS, BCBA
• Jennifer Suzanne McComb, PHARMD
• Kersten McConnell, RBT
• Laura Elizabeth McConnell, LMHCA

• Pediatric Occupational Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatric Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.