Individual
MRS. KELLY COBB NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTRL
Contact information
Practice address
1203 BOMBAY LN, ROSWELL, GA 30076-5822
(770) 851-9553
(770) 698-4178
Mailing address
3990 CAMDEN WAY, ALPHARETTA, GA 30005-3496
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT03452
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930130
BCBS PIN
GA
Enumeration date
12/27/2006
Last updated
07/08/2007
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