Provider Demographics
NPI:1538403035
Name:HOUSTON, KELLY MEREDITH (OT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MEREDITH
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 ROSEWALK LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-7200
Mailing Address - Country:US
Mailing Address - Phone:540-309-0751
Mailing Address - Fax:
Practice Address - Street 1:1507 ROSEWALK LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-7200
Practice Address - Country:US
Practice Address - Phone:540-309-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003838225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation