Individual
KELLY PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1649 61ST ST, STE 301 3RD FLOOR, BROOKLYN, NY 11204-3319
(970) 302-7380
Mailing address
2067 ROAD 39 W, KIMBALL, NE 69145-9751
(970) 302-7380
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/23/2025
Last updated
05/23/2025
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