Individual
ELIZABETH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10760 OPAL ST NE, CIRCLE PINES, MN 55014-1534
(651) 792-5099
Mailing address
10760 OPAL ST NE, CIRCLE PINES, MN 55014-1534
(651) 792-5099
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201500
MN
Other
Enumeration date
11/26/2014
Last updated
11/26/2014
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