Individual
KELSEY LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 S MARTIN LUTHER KING JR DR, WINSTON SALEM, NC 27110-6300
(336) 750-2000
Mailing address
421 MORSE ST, MOCKSVILLE, NC 27028-2829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/04/2019
Last updated
07/06/2021
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