Individual
KALEIGH RENEE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2012 IRONWOOD CIR, SOUTH BEND, IN 46635-1888
(574) 387-4049
Mailing address
108 TAYLORS WAY, NORTH LIBERTY, IN 46554-9224
(574) 360-9996
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003182A
IN
Other
Enumeration date
01/06/2021
Last updated
01/06/2021
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