Keely Pelliccio, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

6127 Issued in SC

Practice address

3851 Commercial Center Dr
Ladson, SC 29456-4146

Phone

(843) 314-5434

NPI assigned

Apr 9, 2021

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

Other identifiers 1

Other names 1

• Keely Petrick Former name

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 and National Provider Directory roles.

• Tri-County Therapy, LLC

  • Speech-Language Pathologist
  • Ladson, SC
  • NPI 1447591607

  Occupational Therapist

  NPD (past)

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1730769167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3851 COMMERCIAL CENTER DR",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564146",
            "telephone_number": "843-314-5434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 COMMERCIAL CENTER DR",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564146",
            "telephone_number": "843-314-5434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLICCIO",
        "first_name": "KEELY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-09",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "6127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TH4553",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEELY",
            "last_name": "PETRICK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bridget C Patterson
• Regan Olivia Payne, OTR/L
• Emily Jordan Peacock, PA-C
• Stephanie Pecht
• Pediatric Early Intervention & Developmental Services
• Shanika Pendergrass
• Miranda Mae Perez, M.S., CCC-SLP
• Kaylee Perry, LMSW
• Douglas Peters, RPH
• Phelan Giles Piehota, D.O.

• Occupational Therapist in Ladson, SC
• Providers in Ladson, SC by specialty
• Occupational Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.