Individual
MS. KELLY DARLING QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
379 PINEHAVEN STREET EXT, LAURENS, SC 29360-2672
(864) 984-6584
Mailing address
1409 ROPER MOUNTAIN RD, APT. 269, GREENVILLE, SC 29615-5101
(864) 325-7073
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2758
SC
Other
Enumeration date
05/01/2011
Last updated
08/08/2011
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