Individual
KAILEY GRACE CLEGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
104 MAXWELL AVE, GREENWOOD, SC 29646-2641
(864) 229-7529
Mailing address
PO BOX 3023, GREENWOOD, SC 29648-3023
(864) 229-7529
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5378
SC
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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