Individual
KELLY KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
915 E BARKER ST, TUSCOLA, IL 61953-1121
(217) 778-5276
Mailing address
915 E BARKER ST, TUSCOLA, IL 61953-1121
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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