Individual
KELLYN PERRI GRACE KANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4045 N QUINLAND LAKE RD, COOKEVILLE, TN 38506-3322
(337) 496-6800
Mailing address
4045 N QUINLAND LAKE RD, COOKEVILLE, TN 38506-3322
(337) 496-6800
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
TN
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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