Individual
KELLY ANN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
1450 E JOLIET ST STE 206, CROWN POINT, IN 46307-4726
(219) 801-3937
(219) 301-8734
Mailing address
1450 E JOLIET ST STE 206, CROWN POINT, IN 46307-4726
(219) 801-3937
(219) 301-8734
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
213000351
IL
224P00000X
Prosthetist
211000319
IL
Other
Enumeration date
08/01/2017
Last updated
07/25/2023
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