Individual
KELSEY MACKERETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1119 OWENS ST N, STILLWATER, MN 55082-4316
(651) 439-7180
Mailing address
1119 OWENS ST N, STILLWATER, MN 55082-4316
(651) 439-7180
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
360360
MN
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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