Individual
KELLY CHRISTINE WORTKOETTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DSP
Contact information
Practice address
9 AMBER MOOR DR UNIT 103, GALLOWAY, OH 43119-3506
(614) 878-4208
Mailing address
5006 DIERKER RD APT B5, COLUMBUS, OH 43220-5224
(814) 573-4707
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RN876190
OH
Other
Enumeration date
11/18/2025
Last updated
11/18/2025
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