Kelly A Wetherbee, OTR/L, DMI, SWC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OTR 6869 Issued in CA

Practice address

4144 Ocean View Blvd
Montrose, CA 91020

Phone

(323) 459-3055

Fax

(661) 254-1862

NPI assigned

Mar 3, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Lealos Former name

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": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1922490713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4144 OCEAN VIEW BLVD",
            "city": "MONTROSE",
            "state": "CA",
            "postal_code": "91020",
            "telephone_number": "323-459-3055",
            "fax_number": "661-254-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4144 OCEAN VIEW BLVD",
            "city": "MONTROSE",
            "state": "CA",
            "postal_code": "91020",
            "telephone_number": "323-459-3055",
            "fax_number": "661-254-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETHERBEE",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "OTR/L, DMI, SWC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CA",
            "license": "OTR 6869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LEALOS",
            "credential": "OTR/L, SWC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pediatric Occupational Therapist in Montrose, CA
• Providers in Montrose, CA by specialty
• Pediatric Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.