Individual
KELLY RAE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13881 SCHUELKE BEACH RD NW, MILTONA, MN 56354
(218) 639-1843
Mailing address
13881 SCHUELKE BEACH RD NW, MILTONA, MN 56354-8300
(218) 639-1843
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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