Individual
KELLY MCCOLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
7506 COVINGTON HOLLOW LN, FORT WAYNE, IN 46804-6152
(405) 919-8142
Mailing address
7506 COVINGTON HOLLOW LN, FORT WAYNE, IN 46804-6152
(405) 919-8142
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT1754
OK
Other
Enumeration date
04/04/2017
Last updated
09/20/2020
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