Kelly Anne Staley, MSOT, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

7039 Issued in TN

Practice address

851 Professional Park Dr
Clarksville, TN 37040-5257

Phone

(931) 542-2168

Fax

(615) 619-2388

NPI assigned

Aug 18, 2021

Last updated

Aug 18, 2021By the provider in NPPES

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Therapy Solutions

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clarksville, TN
  • NPI 1326269119
  NPD (past)

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1699441741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1269 GENTRY DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370431639",
            "telephone_number": "636-328-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 PROFESSIONAL PARK DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405257",
            "telephone_number": "931-542-2168",
            "fax_number": "615-619-2388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "credential": "MSOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "7039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carissa Stacey
• Juliann Stafford
• Justin Stafford
• Kimyunna Latrece Stafford
• Danielle Staley, DPT
• Jill Standley, PMHNP-BC
• Stanford Heights and Associates
• Kristy Jo Stanislav, DDS
• Leon E Stanislav, DDS
• Duncan Stankevich, PHARMD

• Occupational Therapist in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Occupational Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.