Individual
KELLY L REILLY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4211 E 4TH ST APT 9, LONG BEACH, CA 90814-4912
(562) 355-2719
Mailing address
4211 EAST 4TH STREET #9, LONG BEACH, CA 90814
(562) 355-2719
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1807
CA
Other
Enumeration date
10/14/2009
Last updated
10/14/2009
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