Individual
PATRICK KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
52565 SR 933, SOUTH BEND, IN 46637
(574) 247-7044
Mailing address
1512 OAKDALE DR, SOUTH BEND, IN 46614-2847
(574) 323-6772
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001291A
IN
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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