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Individual

KELLY JENKINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1231 WOODFIELD AVE, SOUTH BEND, IN 46615-3803
(574) 222-8786
Mailing address
1231 WOODFIELD AVE, SOUTH BEND, IN 46615-3803
(574) 222-8786

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003106A
IN

Other

Enumeration date
12/23/2016
Last updated
12/23/2016
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