Healthcare Provider Details

I. General information

NPI: 1700090628
Provider Name (Legal Business Name): KATHRYN A KELM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

4410 FLEMING WAY
PLYMOUTH MI
48170-6445
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9610
  • Fax:
Mailing address:
  • Phone: 734-354-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501002332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: