Individual
KELLEY GRACE HERSKOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MRS.
Contact information
Practice address
1165 MONTGOMERY DR, SANTA ROSA, CA 95405
(707) 637-3276
Mailing address
324 MARIA DR, PETALUMA, CA 94954
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11709
CA
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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