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Individual
KELLY KANNENBERG
Active
Individual
KELLY KANNENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4036-T
CA
225400000X
Rehabilitation Practitioner
Primary
4036-T
CA
225800000X
Recreation Therapist
4036-T
CA
Other
Enumeration date
12/28/2006
Last updated
08/13/2025
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