Individual
MR. JOHN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1118 POINDEXTER AVE W, BREMERTON, WA 98312-4337
(360) 204-1723
Mailing address
1118 POINDEXTER AVE W, BREMERTON, WA 98312-4337
(360) 204-1723
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CG60419820
WA
Other
Enumeration date
02/23/2016
Last updated
10/31/2016
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