Individual
MRS. KELLIE MCBROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2544 MANGUM ST, COMMERCE, TX 75428-3515
(903) 886-7669
(903) 886-7679
Mailing address
PO BOX 64, CELESTE, TX 75423-0064
(903) 568-8558
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110810
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8T3108
BCBS PROVIDER
TX
Enumeration date
08/04/2006
Last updated
07/08/2007
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