Individual
KELLY KUBACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
522 SIXTH BAXTER XING, FORT MILL, SC 29708-6613
(803) 752-4780
Mailing address
W276S9075 HIDDEN LAKES DR, MUKWONAGO, WI 53149-9654
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
10/18/2019
Last updated
10/18/2019
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