KELLY ANN ROTH

CROWN POINT, IN
NPI1790209864
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy222Z00000X 
(Licence: IL  213000351)
Additional Taxonomies224P00000X Prosthetist
(Licence: IL  211000319)
Enumeration Date2017-08-01
Last Update Date2023-07-25
Business Address
KELLY ANN ROTH CPO
1450 E JOLIET ST STE 206
CROWN POINT, IN 46307-4726
Phone number: 219-801-3937
Mailing Address
KELLY ANN ROTH CPO
1450 E JOLIET ST STE 206
CROWN POINT, IN 46307-4726
Phone number: 219-801-3937
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