Individual
KELLY HAUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
11830 N 19TH AVE APT 101, PHOENIX, AZ 85029-3520
(602) 443-5447
Mailing address
132 MIDVALE DR, FAIRPORT, NY 14450-1230
(585) 507-2739
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
023993
NY
Other
Enumeration date
04/19/2021
Last updated
02/01/2024
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