Individual
NICOLE GAIL KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LOTR
Contact information
Practice address
112 N 3RD ST, LEESVILLE, LA 71446-4014
(337) 239-3334
Mailing address
106 MAYHAW ST, DERIDDER, LA 70634-2005
(717) 514-7229
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
305553
LA
Other
Enumeration date
09/18/2017
Last updated
09/18/2017
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