Individual
KELLY LERVICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4530 NORTHERN SKY DR, BISMARCK, ND 58503-8534
(701) 751-6336
(701) 751-6337
Mailing address
4530 NORTHERN SKY DR, BISMARCK, ND 58503-8534
(701) 751-6336
(701) 751-6337
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
56
ND
Other
Enumeration date
10/05/2015
Last updated
12/11/2019
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