Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT00002429 | WA |
NPI | 1114278785 |
---|---|
Provider Name | Mrs. Karen Joyce Kellett |
First Address | Edgewood, WA 98372-1107 |
Second Address | Federal Way, WA 98003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 24/09/2012 |