Individual
KELLY BAULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
215 W 3RD AVE, GASTONIA, NC 28052-4058
(704) 866-6160
Mailing address
10620 HILL POINT CT, CHARLOTTE, NC 28262-2673
(704) 408-3569
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3756
NC
224Z00000X
Occupational Therapy Assistant
Primary
U2-0000927
DE
Other
Enumeration date
03/22/2011
Last updated
04/17/2026
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