Provider Demographics
NPI:1114816980
Name:FORLINES, KELSEY TURNER (COTA/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:TURNER
Last Name:FORLINES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 CENTRAL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2643
Mailing Address - Country:US
Mailing Address - Phone:662-424-3476
Mailing Address - Fax:
Practice Address - Street 1:1690 DOUBLE LOG CABIN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-7471
Practice Address - Country:US
Practice Address - Phone:615-444-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3598224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant