Individual
KELLIE LOVE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3492 MARTIN HURST RD, TALLAHASSEE, FL 32312-1702
(850) 294-9716
Mailing address
12495 HOLEY RD, TALLAHASSEE, FL 32317-9607
(850) 322-8219
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA14701
FL
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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