Individual
KATHLEEN PREMOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
917 BEVILLE RD, SUITE G, SOUTH DAYTONA, FL 32119-1712
(386) 756-4395
(866) 426-2811
Mailing address
113 TOWNSEND RD, MARMORA, NJ 08223-1133
(941) 223-5994
(866) 426-2811
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09070500
NJ
Other
Enumeration date
01/27/2010
Last updated
01/27/2010
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