Individual
KELLY MARIE BANKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 VISTA TERRACE S., MAHOPAC, NY 10541
(917) 449-0168
Mailing address
120 VISTA TERRACE S., MAHOPAC, NY 10541
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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