Individual
MR. KYLE ANDREW KEGERREIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
17 CHIPMAN WAY, KINGSTON, MA 02364-1039
(781) 585-4100
Mailing address
12 OGDEN ST, PROVIDENCE, RI 02906-4904
(615) 294-1267
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4407
MA
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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