Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1053755488 |
---|---|
Provider Name | Miss Paige Kelly |
First Address | Las Vegas, NV 89146-5667 |
Second Address | Las Vegas, NV 89146-5667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 14/03/2016 |