Individual
KETHLIE FABIEN CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5700 LAKE WORTH RD STE 106, GREENACRES, FL 33463-3213
(561) 439-3991
(561) 439-3993
Mailing address
5700 LAKE WORTH RD STE 106, GREENACRES, FL 33463-3213
(561) 439-3991
(561) 439-3993
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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