Individual
KELLIE NICHOLE HEUBLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
500 TAMAL PLZ STE 527, CORTE MADERA, CA 94925-1187
(707) 339-0651
Mailing address
29 JOAN AVE, NOVATO, CA 94947-4120
(707) 339-0651
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
14266
CA
225XP0200X
Pediatric Occupational Therapist
Primary
14266
CA
Other
Enumeration date
05/07/2018
Last updated
05/08/2018
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