Provider Demographics
NPI:1407490352
Name:SNIDER, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NATCHEZ AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-4058
Mailing Address - Country:US
Mailing Address - Phone:601-754-1029
Mailing Address - Fax:
Practice Address - Street 1:402 NATCHEZ AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-4058
Practice Address - Country:US
Practice Address - Phone:601-754-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist