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General NPI Number Information
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NPI Number | 1336267624
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Entity Type | Individual
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Provider Name | MRS. NICOLE KELLY
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 155 LANDOVER PL
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City | LONGWOOD
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State | FL
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Zip | 32750-4924
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Country | US
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Telephone | 407-830-7744
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Fax | 407-830-7926
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Provider Business Mailing Address
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Address Line | 4465 GABRIELLA LN
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City | WINTER PARK
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State | FL
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Zip | 32792-6325
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Country | US
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Telephone | 407-619-6204
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Fax | 407-671-1604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6608
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License Number State | FL
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