Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0887 | NH |
NPI | 1003029091 |
---|---|
Provider Name | Ms. Susan Eve Kelly |
First Address | Alton Bay, NH 03810-6071 |
Second Address | Laconia, NH 03246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |