Individual
KEVIN MICHAEL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1287 CEDAR SHOALS DR APT 718, ATHENS, GA 30605-3596
(302) 753-5608
Mailing address
1287 CEDAR SHOALS DR, ATHENS, GA 30605-3552
(302) 753-5608
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005995
GA
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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