Individual
KELSEY JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12045 SE STANLEY AVE, MILWAUKIE, OR 97222
(503) 659-2323
Mailing address
4130 REDTAIL PASS, MIDDLETON, WI 53562
(608) 628-4807
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
07/21/2016
Last updated
07/21/2016
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