Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CX0006X | Orientation and Mobility Training Provider | 1938 | AZ |
NPI | 1609112432 |
---|---|
Provider Name | Mr. John Joseph Kelly |
First Address | Chester, NY 10918-1584 |
Second Address | Chester, NY 10918-1584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2012 |
Last Update Date | 27/12/2012 |