Provider Demographics
NPI:1043778327
Name:TILLETT, KELSEY (OT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TILLETT
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 1:3166 CLARKSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-8015
Mailing Address - Country:US
Mailing Address - Phone:903-784-7702
Mailing Address - Fax:903-784-7703
Practice Address - Street 1:3166 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8015
Practice Address - Country:US
Practice Address - Phone:903-784-7702
Practice Address - Fax:903-784-7703
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118715225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118715OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS