Basic Information
| Provider Information | |||||||||
| NPI: | 1013453885 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FRYE | ||||||||
| FirstName: | KELLY | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6150 ALMA RD APT 2262 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750707322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075774964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 W EXCHANGE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750137018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145471571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2017 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT18191 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 119842 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 019888000 | 05 | FL | MEDICAID |