Individual
MRS. KELLY KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
N4901 DAM RD, DELAVAN, WI 53115-2927
(262) 740-2170
Mailing address
W9623 WALWORTH WOODS RD, DELAVAN, WI 53115-2438
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0720000540
VT
225X00000X
Occupational Therapist
Primary
4194-26
WI
Other
Enumeration date
03/19/2007
Last updated
09/06/2012
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