Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ILANA NICOLE KELLOGG WAASDORP, PT, DPT
Active Sole ProprietorILANA NICOLE KELLOGG WAASDORP, PT, DPT is a Pediatric Occupational Therapy healthcare provider located in ROANOKE, Virginia. NPI 1720425549 is currently active in the NPPES registry. Verify at CMS.
Pediatric Occupational Therapy · ROANOKE, VA
Registration Details
- NPI Number
- 1720425549
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jun 3, 2013 (13.200644009962 yrs)
- Last Updated
- Jan 2, 2020
- Licenses
-
PTL.0012174 (CO)2305212941 (VA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1421 3RD ST SWROANOKE, VA, 240165204Browse VA providers · Browse ZIP 24016
- Phone
- 3039003457
- Primary Specialty
-
Pediatric Occupational Therapy
2251P0200X
- Additional Specialty
- Pediatric Occupational Therapy
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.