Individual
MRS. KELLIE SUE EBBOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3305 S ORANGE AVE, ORLANDO, FL 32806-6125
(407) 852-3300
Mailing address
654 ASCOT CIR, ORLANDO, FL 32825-3215
(757) 434-4899
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/04/2009
Last updated
08/04/2009
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