Healthcare Provider Details

I. General information

NPI: 1164903209
Provider Name (Legal Business Name): KAMI KEDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80650 VAN DYKE RD
BRUCE TWP MI
48065-1333
US

IV. Provider business mailing address

80650 VAN DYKE RD
BRUCE TWP MI
48065-1333
US

V. Phone/Fax

Practice location:
  • Phone: 810-798-6470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502001404
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: