Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4307 | AL |
NPI | 1043718075 |
---|---|
Provider Name | Ms. Kelsey Renee Joseph |
First Address | Montgomery, AL 36109-3725 |
Second Address | Tuskegee, AL 36083-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2018 |
Last Update Date | 24/01/2018 |