Provider Demographics
NPI:1528070372
Name:KELLEY, JEAN (OT)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:MACLEOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1102 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2780
Mailing Address - Country:US
Mailing Address - Phone:931-762-5593
Mailing Address - Fax:
Practice Address - Street 1:374 BRINK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3280
Practice Address - Country:US
Practice Address - Phone:931-762-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT2148225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist