Healthcare Provider Details

I. General information

NPI: 1194463505
Provider Name (Legal Business Name): KAREN ANNE LILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HOWARD ST
KALAMAZOO MI
49008-1919
US

IV. Provider business mailing address

605 HOWARD ST
KALAMAZOO MI
49008-1919
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-8770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202005363
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: