Individual
KELLY JEAN HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2760 DORA AVE, TAVARES, FL 32778
(352) 742-7837
(352) 508-5113
Mailing address
6406 SANSON DR, APOPKA, FL 32712-5224
(407) 883-0978
(352) 508-5113
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA12026
FL
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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