Provider Demographics
NPI:1548064009
Name:EDWARDS, KELSEY (COTA/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
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 1:1813 W BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-4609
Mailing Address - Country:US
Mailing Address - Phone:479-763-5990
Mailing Address - Fax:
Practice Address - Street 1:6301 HIGHWAY 45 STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-8857
Practice Address - Country:US
Practice Address - Phone:479-322-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A2112224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant