Individual
KELLEY ANNE HIERONYMUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
817 E PLUM ST, MOSES LAKE, WA 98837-1870
(509) 765-7835
Mailing address
2013 LEANNE AVE, MOSES LAKE, WA 98837-2599
(509) 765-3041
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC 00000444
WA
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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