Individual
KELLY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
12111 N 66TH AVE, GLENDALE, AZ 85304-1625
(573) 569-0144
Mailing address
12111 N 66TH AVE, GLENDALE, AZ 85304-1625
(573) 569-0144
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
5909
AZ
Other
Enumeration date
03/17/2015
Last updated
03/17/2015
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