Individual
KELLEY BROYLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
155 PALISADES DR, DALLAS, GA 30157-0927
(404) 579-8307
Mailing address
155 PALISADES DR, DALLAS, GA 30157-0927
(404) 579-8307
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003284
GA
Other
Enumeration date
12/28/2006
Last updated
04/13/2012
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