Individual
KELLI MENDIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 SE STEPHENS ST, ROSEBURG, OR 97470-4818
(541) 900-1418
Mailing address
1000 SE STEPHENS ST, ROSEBURG, OR 97470-4818
(541) 900-1418
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234567
—
OR
Enumeration date
07/11/2019
Last updated
11/27/2023
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