Individual
CORINNE NICOLE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
14370 LEE HWY STE 104, GAINESVILLE, VA 20155-4865
(703) 565-4115
(703) 754-4435
Mailing address
14029 BREEDERS CUP DR, GAINESVILLE, VA 20155-3142
(703) 565-4115
(703) 754-4435
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
0119007846
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
09/08/2018
Last updated
09/08/2018
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