Individual
KELSEY STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 765-9655
Mailing address
6546 BOWMAN RD, POUND, VA 24279-2843
(276) 219-2307
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0131001653
VA
224Z00000X
Occupational Therapy Assistant
Primary
2785
TN
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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