Individual
KELLY LYNN CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
805 19TH AVE SE, ALBANY, OR 97322-4225
(541) 401-4887
Mailing address
2173 ARROYO RIDGE DR, ALBANY, OR 97321-1076
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
390246
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390246
NONE APPLICABLE
OR
Enumeration date
05/19/2020
Last updated
05/19/2020
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