Individual
STEPHEN PATRICK KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
6080 JERICHO TPKE STE 200, COMMACK, NY 11725-2808
(631) 979-7224
(631) 979-7224
Mailing address
37 WESTWOOD LN, KINGS PARK, NY 11754-5122
(631) 979-7224
(631) 979-7224
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
7141919
NY
Other
Enumeration date
09/11/2012
Last updated
09/11/2012
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