Individual
KELLY WILLEMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12968 ECHO LN, APPLE VALLEY, MN 55124-8656
(952) 288-4653
Mailing address
12968 ECHO LN, APPLE VALLEY, MN 55124-8656
(952) 288-4653
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201955
MN
Other
Enumeration date
09/13/2015
Last updated
09/13/2015
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