Individual
KELLY JEAN VANSCIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 N CENTRAL AVE STE 110, KISSIMMEE, FL 34741-4439
(407) 201-7429
Mailing address
242 HURST RD NE, PALM BAY, FL 32907-1566
(321) 614-8705
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/06/2020
Last updated
10/20/2023
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