Individual
KELLY MARIE NORTHNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASTERS
Contact information
Practice address
1150 LORYN LN, HALF MOON BAY, CA 94019-1447
(408) 835-4672
Mailing address
1150 LORYN LN, HALF MOON BAY, CA 94019-1447
(408) 835-4672
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
11265
MA
225XP0200X
Pediatric Occupational Therapist
Primary
12588
CA
Other
Enumeration date
09/22/2014
Last updated
12/12/2022
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