Individual
KELLY R. DIETEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
10J GILL ST, WOBURN, MA 01801-1721
(781) 932-2888
Mailing address
20 CANTERBURY RD, WINCHESTER, MA 01890-3813
(781) 721-1322
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/02/2012
Last updated
11/07/2012
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