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Individual
KELLY LISA MIDKIFF
Active
Individual
KELLY LISA MIDKIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
209419
TX
225XP0019X
Physical Rehabilitation Occupational Therapist
209419
TX
225XP0200X
Pediatric Occupational Therapist
209419
TX
Other
Enumeration date
03/09/2016
Last updated
03/09/2016
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