Individual
KEITORIA RAYCHELLE LACOUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 SUNSET RD, BURLINGTON, NJ 08016-4153
(609) 387-3620
Mailing address
350 E WILLOW GROVE AVE APT 606, PHILADELPHIA, PA 19118-4429
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00432800
NJ
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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