Individual
MR. JAMES KELLY BAZELAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
600 S BROAD ST, KENNETT SQUARE, PA 19348-3346
(610) 924-4561
Mailing address
944 E JOHNSON ST, PHILADELPHIA, PA 19138-1065
(267) 983-7030
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
OP007379
PA
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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