Provider Demographics
NPI:1043641723
Name:MCLAIN, KELLI TRETTER (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:TRETTER
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2176 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3869
Mailing Address - Country:US
Mailing Address - Phone:901-328-2110
Mailing Address - Fax:
Practice Address - Street 1:2176 WEST ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3869
Practice Address - Country:US
Practice Address - Phone:901-328-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000003448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist