Individual
SUZANNE MARIE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6100 W FRIENDLY AVE, GREENSBORO, NC 27410-4160
(336) 292-1301
Mailing address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
9297
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9297
NC STATE BOARD OF OCCUPATIONAL THERAPY
NC
Enumeration date
08/25/2021
Last updated
08/25/2021
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