Provider Demographics
NPI:1548692387
Name:KELTY, TIFFANNY BLAIR (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:TIFFANNY
Middle Name:BLAIR
Last Name:KELTY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:TIFFANNY
Other - Middle Name:BLAIR
Other - Last Name:HAVERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 MIDLAND TRL
Mailing Address - Street 2:SUITE 1 AND 2
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8141
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:
Practice Address - Street 1:1900 MIDLAND TRL
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8141
Practice Address - Country:US
Practice Address - Phone:502-633-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R4320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist