Individual
KELLIE SORRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1742 WALTER STONE RD, SPARTA, TN 38583-5748
(931) 254-1662
Mailing address
1742 WALTER STONE RD, SPARTA, TN 38583-5748
(931) 254-1662
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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