Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT17302 | FL |
NPI | 1023488400 |
---|---|
Provider Name | Kelsey Lavelle |
First Address | Hobe Sound, FL 33455-5444 |
Second Address | Tequesta, FL 33469-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2015 |
Last Update Date | 29/09/2015 |