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General NPI Number Information
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NPI Number | 1750792701
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Entity Type | Individual
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Provider Name | CAROLYN KETTELSON CSCM
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 9130 GALLERIA CT SUITE 103
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City | NAPLES
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State | FL
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Zip | 34109-4380
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Country | US
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Telephone | 230-449-4747
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Fax | 239-790-5035
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Provider Business Mailing Address
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Address Line | 9130 GALLERIA CT SUITE 103
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City | NAPLES
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State | FL
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Zip | 34109-4380
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Country | US
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Telephone | 230-449-4747
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Fax | 239-790-5035
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 299994241
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License Number State | FL
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