| NPI | 1033608815 |
|---|---|
| Former Name | KELLIE NICHOLE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: CA 14266) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 14266) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-08 |