Individual
NICOLE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35 N 28TH ST, SUPERIOR, WI 54880-5557
(715) 392-3300
Mailing address
4038 MUNGER SHAW RD, CLOQUET, MN 55720-9255
(218) 590-9285
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2340-19
WI
225200000X
Physical Therapy Assistant
A1718
MN
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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