Individual
MRS. KELLY M HENNESSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
16606 SADDLE CLUB RD, WESTON, FL 33326-1808
(954) 660-0551
(954) 660-0527
Mailing address
2620 S UNIVERSITY DR, 308, DAVIE, FL 33328-1469
(954) 648-5888
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT11129
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z065P
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/11/2006
Last updated
07/09/2007
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