Individual
MRS. KELLY ANNE FONVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTR IL
Contact information
Practice address
3301 OVERBROOK DR, CONOVER, NC 28613-8227
(828) 256-9488
Mailing address
3301 OVERBROOK DR, CONOVER, NC 28613-8227
(828) 256-9488
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5956
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141MY
BCBS
NC
01
—
185536
MEDCOST
NC
05
—
7301880
—
NC
Enumeration date
02/06/2006
Last updated
07/25/2007
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