Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 007785 | AZ |
NPI | 1154982981 |
---|---|
Provider Name | Kelsey Roberts |
First Address | Saint Charles, MO 63303-6557 |
Second Address | Christiansted, VI 00820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |