Individual
KELLY MCINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1800 BUCKNER ST STE C249, SHREVEPORT, LA 71101-4447
(318) 934-1969
Mailing address
PO BOX 1377, WEST MONROE, LA 71294-1377
(318) 396-1969
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z12020
LA
Other
Enumeration date
06/22/2018
Last updated
06/22/2018
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