Individual
KELLEY SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4161 TAMIAMI TRAIL, SUITE 704, PORT CHARLOTTE, FL 33953-9283
(941) 625-1110
(941) 625-0552
Mailing address
4161 TAMIAMI TRAIL, SUITE 704, PORT CHARLOTTE, FL 33953-9283
(941) 625-1110
(941) 625-0552
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA26328
FL
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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