Provider Demographics
NPI:1942629506
Name:KELLAM, MICHELLE LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:KELLAM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4350 WILL ROGERS PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1808
Mailing Address - Country:US
Mailing Address - Phone:405-948-2813
Mailing Address - Fax:
Practice Address - Street 1:12899 E 76TH ST N
Practice Address - Street 2:STE. 109
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4021
Practice Address - Country:US
Practice Address - Phone:918-609-6003
Practice Address - Fax:918-609-6002
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant