Individual
BENJAMIN KELSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 MIRA MAR AVE STE 1, MEDFORD, OR 97504-8588
(800) 848-7868
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
368677
OR
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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