Individual
KELLY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
300 E MAZON AVE, DWIGHT, IL 60420-1104
(815) 584-9268
Mailing address
150 MEADOWS RD S, BOURBONNAIS, IL 60914-1127
(815) 644-1332
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.006115
IL
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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