Individual
MR. KELLY LON DREVECKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT R/L
Contact information
Practice address
700 HARMONY ST NW, MINOT, ND 58703-2892
(701) 720-5355
(701) 839-1311
Mailing address
700 HARMONY ST NW, MINOT, ND 58703-2892
(701) 720-5355
(701) 839-1311
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
612
ND
225XN1300X
Neurorehabilitation Occupational Therapist
612
ND
225XP0200X
Pediatric Occupational Therapist
Primary
612
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50609
—
ND
Enumeration date
05/16/2006
Last updated
08/07/2008
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