Individual
KELLI LYNN TENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1475 N GRANITE REEF RD, SCOTTSDALE, AZ 85257-3919
(480) 990-1904
Mailing address
1475 N GRANITE REEF RD, SCOTTSDALE, AZ 85257-3919
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6379
AZ
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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