Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5201005603 | MI |
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201005603 | MI |
NPI | 1801180310 |
---|---|
Provider Name | Mrs. Kimberly Ann Kelly |
First Address | Saginaw, MI 48602-4316 |
Second Address | Saginaw, MI 48602-4316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 24/04/2018 |