Individual
MR. JAY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTL
Contact information
Practice address
205 E KINGS HWY, EDEN, NC 27288-5239
(336) 623-9712
Mailing address
4401 BRECON LN, GREENSBORO, NC 27407-6158
(910) 620-5672
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3129
NC
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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