Individual
LISA KELLAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5526 EAGLES NEST DR, WILMINGTON, NC 28409-2515
(910) 508-6438
Mailing address
5526 EAGLES NEST DR, WILMINGTON, NC 28409-2515
(910) 508-6438
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2225
NC
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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