Individual
KELLY PRUETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
6200 WHIPPLE AVE NW, NORTH CANTON, OH 44720-7624
(330) 966-8614
Mailing address
4167 GEORGIA ST NW, MASSILLON, OH 44646-3266
(330) 477-2968
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002478
OH
225XP0200X
Pediatric Occupational Therapist
OT 002478
OH
Other
Enumeration date
05/23/2007
Last updated
07/27/2007
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