Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053849166 |
---|---|
Provider Name | Ms. Nicole Shavon Kelly |
First Address | Towson, MD 21284-0093 |
Second Address | Timonium, MD 21093-1338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2017 |
Last Update Date | 22/07/2019 |