Mary Jo Kelly, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0119007492 Issued in VA

Practice address

1191 Bellamy Tipton Rd
Gate City, VA 24251-5046

Phone

(239) 292-7489

NPI assigned

Mar 26, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

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": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1578068185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 BELLAMY TIPTON RD",
            "city": "GATE CITY",
            "state": "VA",
            "postal_code": "242515046",
            "telephone_number": "239-292-7489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 BELLAMY TIPTON RD",
            "city": "GATE CITY",
            "state": "VA",
            "postal_code": "242515046",
            "telephone_number": "239-292-7489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3327 Island Rd",
            "address_purpose": "LOCATION",
            "city": "Blountville",
            "state": "TN",
            "postal_code": "376173648",
            "country_code": "US",
            "telephone_number": "276-646-8911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARY JO",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "5809",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "TN",
            "license": "OT0000004939",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "OT0000004939",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "0119007492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OT LICENSE",
            "identifier": "0119007492",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "134421797",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE OT",
            "identifier": "OT0000004939",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey D. Montgomery, DDS, PC
• Cynthia Jessee, CPNP
• Benjamin H Jones III, BSW
• Carolina Brooke Jones, RBT
• Jeremy Thomas Keller, MS
• Teresa B Landore, DO
• Teresa Lynn Maness, LPTA
• Lindsay Nicole Martinez, PSY.D.
• Sadie Rebecca McAbee, M.S.
• Jason McCully, LPTA

• Occupational Therapist in Gate City, VA
• Providers in Gate City, VA by specialty
• Occupational Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.