Individual
KELSEY LYN DIDERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 ROGERS COURT, WEBSTER, TX 77598
(713) 797-5942
Mailing address
1450 E LEAGUE CITY PKWY APT 4112, LEAGUE CITY, TX 77573-6038
(801) 735-6361
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
478389
TX
Other
Enumeration date
11/21/2022
Last updated
11/21/2022
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