Individual
ANGELA M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3261 HWY 49 SOUTH, VA STATE HOME/COLLINS, COLLINS, MS 39428
(601) 206-9195
(601) 957-8391
Mailing address
P.O. BOX 315, RIDGELAND, MS 39158
(601) 206-9195
(601) 957-8391
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0277
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014160
—
MS
Enumeration date
11/06/2012
Last updated
10/11/2019
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