Provider Demographics
NPI:1932470275
Name:MCLEOD, KELLY ANDRASIK
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANDRASIK
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:ANDRASIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:REHABILITATION SERVICES - 3RD FLOOR
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8218
Mailing Address - Fax:650-497-8491
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:REHABILITATION SERVICES - 3RD FLOOR
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8218
Practice Address - Fax:650-497-8491
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR238537225X00000X
CA11652225X00000X
L-157334174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA053305Medicaid
CA053305Medicaid