Individual
KELLY CLONINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 PICKETT RD, DURHAM, NC 27705-5688
(919) 419-9600
Mailing address
4408 DOLWICK DR, DURHAM, NC 27713-6530
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5183
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5183
STATE LICENSE
NC
Enumeration date
05/02/2007
Last updated
07/08/2007
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