Healthcare Provider Details

I. General information

NPI: 1821259599
Provider Name (Legal Business Name): MISS KELLY HEMENWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DADSON DR
LANSING MI
48911-6534
US

IV. Provider business mailing address

401 DADSON DR
LANSING MI
48911-6534
US

V. Phone/Fax

Practice location:
  • Phone: 517-881-1850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: