Individual
KELLEY JEAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
10000 BAY PINES BLVD, 11G/RT, BAY PINES, FL 33744
(727) 398-6661
Mailing address
10000 BAY PINES BLVD, BAY PINES, FL 33744
(727) 398-6661
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15904
NCTRC CERTIFICATION NUMBE
FL
Enumeration date
07/18/2007
Last updated
07/18/2007
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