Individual
NICOLE GUESS KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1600 WESTBROOK AVE, RICHMOND, VA 23227-3337
(804) 256-2092
Mailing address
1890 LOWER MILL RD, POWHATAN, VA 23139-7082
(804) 833-6454
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004916
VA
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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