Individual
KELLEY BROADWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8093 MARIGOLD RD NE, KENSINGTON, OH 44427-9625
(330) 206-4163
Mailing address
8093 MARIGOLD RD NE, KENSINGTON, OH 44427-9625
(330) 206-4163
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
04/15/2025
Last updated
04/15/2025
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