Individual
JACOB RYAN KELP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11104 NE 149TH ST, BRUSH PRAIRIE, WA 98606-9565
(360) 885-5300
Mailing address
1619 33RD AVE, LONGVIEW, WA 98632-3303
(360) 261-0128
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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