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1154864403
KELLEY GRACE HERSKOVIC
SANTA ROSA, CA
NPI
1154864403
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: CA 11709)
Enumeration Date
2016-11-18
Last Update Date
2016-11-18
Business Address
-- KELLEY GRACE HERSKOVIC Mrs.
1165 MONTGOMERY DR
SANTA ROSA, CA 95405
Phone number: 707-637-3276
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Mailing Address
-- KELLEY GRACE HERSKOVIC Mrs.
324 MARIA DR
PETALUMA, CA 94954
Phone number:
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