Individual
KELLI S WETZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
21 PINE ST, EAST MORICHES, NY 11940-1121
(631) 874-4048
Mailing address
21 PINE ST, EAST MORICHES, NY 11940-1121
(631) 874-4048
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
008624-1
NY
Other
Enumeration date
06/30/2015
Last updated
06/30/2015
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