Individual
MR. KELLY ROSS RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS,OTR/L, CLT
Contact information
Practice address
324 1ST AVE N, GEORGE, IA 51237-1029
(712) 475-3391
Mailing address
706 EAGLE RUN, DELL RAPIDS, SD 57022-2142
(605) 428-5851
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01563
IA
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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