Individual
KELLY GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 TOWN CENTER BLVD, ODENTON, MD 21113-1233
(410) 672-8094
Mailing address
1110 TOWN CENTER BLVD STE I, ODENTON, MD 21113-1232
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
05996
MD
Other
Enumeration date
06/28/2018
Last updated
06/23/2020
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