Individual
KETTELIE GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5701 MARY LN, WEST PALM BEACH, FL 33407-1643
(561) 574-6460
Mailing address
6953 MITCHELL STREET, JUPITER, FL 33458
(561) 574-6460
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
6906689
FL
Other
Enumeration date
09/26/2014
Last updated
09/26/2014
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