Individual
KELLY TYLA JORDAN' WATTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6551 MCCARRAN ST APT 2029, NORTH LAS VEGAS, NV 89086-1442
(818) 614-7658
Mailing address
6551 MCCARRAN ST APT 2029, NORTH LAS VEGAS, NV 89086-1442
(818) 614-7658
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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