Individual
KELLY HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 WADDELL LN, SOUTH BOSTON, VA 24592-6263
(434) 470-4114
Mailing address
1209 WADDELL LN, SOUTH BOSTON, VA 24592-6263
(434) 470-4114
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000648
VA
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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