Provider Demographics
NPI:1861729469
Name:STEADMAN, KELLY (OT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STEADMAN
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:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-0117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:336-207-8957
Practice Address - Street 1:110 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7834
Practice Address - Country:US
Practice Address - Phone:336-207-8957
Practice Address - Fax:336-886-1247
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2034225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics