Individual
KELLY WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 2ND ST, MOSCOW, OH 45153-0066
(513) 274-3040
Mailing address
PO BOX 66, MOSCOW, OH 45153-0066
(513) 274-3040
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2885605
—
OH
Enumeration date
10/03/2014
Last updated
10/03/2014
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