Healthcare Provider Details

I. General information

NPI: 1386558260
Provider Name (Legal Business Name): ELIZABETH KETTLEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH O'BRIAN

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10639 SPENCER RD
BRIGHTON MI
48114-7552
US

IV. Provider business mailing address

1425 W GRAND RIVER AVE
HOWELL MI
48843-1916
US

V. Phone/Fax

Practice location:
  • Phone: 810-299-4350
  • Fax:
Mailing address:
  • Phone: 517-546-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: