Individual
MS. KELLI DIANE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1600 WESTBROOK AVE, RICHMOND, VA 23227-3337
(757) 729-2962
Mailing address
1600 WESTBROOK AVE, RICHMOND, VA 23227-3337
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002579
VA
Other
Enumeration date
10/25/2021
Last updated
10/25/2021
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