Individual
DESIRE' KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7262 CRADLEROCK WAY, COLUMBIA, MD 21045-5069
(410) 309-1070
Mailing address
7262 CRADLEROCK WAY, COLUMBIA, MD 21045-5069
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
212926
MD
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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