Kelly Supataraporn

NPI #1083982078 in Bolingbrook, Illinois

Provider Information

NPI Number: 1083982078
Entity Type: Individual
Name: Kelly Supataraporn
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Occupational Therapist
Enumeration Date: Dec 6, 2011
Last Updated: Dec 6, 2011

Practice Location

Address: 388 TWIN CREEKS DR
City: Bolingbrook
State: Illinois
ZIP Code: 60440-1070
Phone: (630) 453-0134

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X	Primary

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