Individual
MRS. KYLAH CHEYENNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
405 CAMPBELL ST, BROKEN BOW, OK 74728-3143
(580) 236-4625
Mailing address
405 CAMPBELL ST, BROKEN BOW, OK 74728-3143
(580) 236-4625
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
2072
OK
224Z00000X
Occupational Therapy Assistant
Primary
215590
TX
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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