Individual
MISS KELLY LEE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2012 IRONWOOD CIR, SUITE 230, SOUTH BEND, IN 46635-1888
(574) 387-4049
Mailing address
1805 MILBURN BLVD, MISHAWAKA, IN 46544-4629
(574) 850-8953
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002094A
IN
Other
Enumeration date
01/21/2012
Last updated
01/21/2012
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