Individual
MRS. KELLY LYNN CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
631 BEACON PKWY W, BIRMINGHAM, AL 35209-3124
(205) 945-4859
Mailing address
5740 CYPRESS TRCE, HOOVER, AL 35244-5478
(205) 426-0358
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2524
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2524
O.T, LICENSE NUMBER
AL
Enumeration date
06/14/2007
Last updated
07/08/2007
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