Kim Nan Kelley, OTRL

Primary specialty

SpecialistTaxonomy code 174400000X

License

102295 Issued in MN

Practice address

3395 Plymouth Rd
Minnetonka, MN 55305-3765

Phone

(952) 939-0396

Fax

(952) 548-8760

NPI assigned

Dec 4, 2006

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

Enrolled in MN

Enrollment records 1

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.

• Kid Talk Inc

  • Speech-Language Pathologist
  • Victoria, MN
  • NPI 1245315027
  Medicare reassignment NPD
• Kid Talk Inc

  • Hearing and Speech Clinic/Center
  • Prior Lake, MN
  • NPI 1508146275
  NPD

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679631899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3395 PLYMOUTH RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553053765",
            "telephone_number": "952-939-0396",
            "fax_number": "952-548-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3395 PLYMOUTH RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553053765",
            "telephone_number": "952-939-0396",
            "fax_number": "952-548-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KIM",
        "middle_name": "NAN",
        "name_prefix": "Ms.",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "102295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Mae Keith, LICSW
• Barbara L Kelii, MA, OTR/L
• Evan Michael Kellar
• Simone M Keller, ANP-BC
• Carrie Kelley
• Mackenzie Gluek Kelley, OTD, OTR/L
• Taylor Kelley
• Maedelin Kelly, LPCC
• Gregory John Kemmitt, DDS
• Lisa Kendrick

• Specialist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.