Individual
MS. MAVIS KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
44 JEFFERSON RD, GLENMONT, NY 12077-3331
(518) 439-3090
Mailing address
44 JEFFERSON RD, GLENMONT, NY 12077-3331
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007621-1
NY
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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