Individual
KELLY ELAIRE MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6 MEDICAL PLAZA DR, ROSEVILLE, CA 95661-3037
(916) 202-8625
Mailing address
3725 MILLBRAE RD, CAMERON PARK, CA 95682-9071
(196) 202-8645
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA913
CA
Other
Enumeration date
10/22/2018
Last updated
10/22/2018
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