Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1093353476 |
---|---|
Provider Name | Myschelle Kelly |
First Address | Dewitt, MI 48820-9089 |
Second Address | Dewitt, MI 48820-9089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2019 |
Last Update Date | 16/12/2019 |