Individual
KELLY EATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1003 PARK ST, OGDENSBURG, NY 13669-3911
(518) 483-3261
Mailing address
1003 PARK ST, OGDENSBURG, NY 13669-3911
(518) 483-3261
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
171M00000X
NY
Other
Enumeration date
03/09/2022
Last updated
03/09/2022
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