Individual
KELLY LYNNE DESTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2150 PINE CREEK BLVD APT 105, VERO BEACH, FL 32966-5204
(845) 803-0564
Mailing address
2150 PINE CREEK BLVD APT 105, VERO BEACH, FL 32966-5204
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
010179
NY
224Z00000X
Occupational Therapy Assistant
Primary
OTA19443
FL
Other
Enumeration date
01/08/2025
Last updated
01/08/2025
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