Individual
KELLY J FORMANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4415 RIO D ORO, SAN ANTONIO, TX 78233-6748
(210) 651-3339
Mailing address
2222 SULLIVAN TRL, EASTON, PA 18040-7958
(610) 991-2034
(610) 991-0205
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
TX
Other
Enumeration date
07/23/2006
Last updated
07/08/2007
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