Mrs. Kelly Anne Fonville
Occupational Therapist - Pediatrics
3301 Overbrook Dr
Conover
, North Carolina 28613-8227
Mrs. Kelly Anne Fonville
Occupational Therapist - Pediatrics
3301 Overbrook Dr
Conover
, North Carolina 28613-8227
(828) 256-9488
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About
Features
Specialties
- Occupational Therapist - Pediatrics
Languages spoken
- English
Location
First Address
- Mrs. Kelly Anne Fonville
- 3301 Overbrook Dr
- Conover, NC
- Zip : 28613-8227
- Phone : (828) 256-9488
Second Address
- Mrs. Kelly Anne Fonville
- 3301 Overbrook Dr
- Conover, NC
- Zip : 28613-8227
- Phone : (828) 256-9488
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225XP0200X | Occupational Therapist - Pediatrics | 5956 | NC |
National Provider Identifier
| NPI | 1063484889 |
|---|---|
| Provider Name | Mrs. Kelly Anne Fonville |
| First Address | Conover, NC 28613-8227 |
| Second Address | Conover, NC 28613-8227 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/02/2006 |
| Last Update Date | 25/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 141MY | BCBS (01) | NC |
| 185536 | MEDCOST (01) | NC |
| 7301880 | (05) | NC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.