Individual
KELLYLYNN MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
779 RIDGEBURY RD, SLATE HILL, NY 10973-3900
(845) 697-5064
Mailing address
P.O.BOX 208, BULLVILLE, NY 10915
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010008
NY
Other
Enumeration date
02/23/2019
Last updated
02/23/2019
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