Individual
KELLIE HATLEY SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 W PHIFER ST, MARSHVILLE, NC 28103-1322
(704) 624-6643
Mailing address
168 RENEE FORD RD, STANFIELD, NC 28163-6737
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
8315
NC
Other
Enumeration date
05/11/2016
Last updated
05/11/2016
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