Individual
MR. KELLY BRYCE JANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 791-2000
Mailing address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2223
SC
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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