Provider Demographics
NPI:1306102512
Name:DRIGGERS, KELLY LYNN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:DRIGGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:210 SHORELINE LN
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8073
Mailing Address - Country:US
Mailing Address - Phone:843-761-1765
Mailing Address - Fax:
Practice Address - Street 1:3409 SALTERBECK CT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7117
Practice Address - Country:US
Practice Address - Phone:843-761-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist