Healthcare Provider Details

I. General information

NPI: 1356967384
Provider Name (Legal Business Name): KAYLI ROSE ZOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 RIDGECREST DR
MIDLAND MI
48642-5860
US

IV. Provider business mailing address

3301 RIDGECREST DR
MIDLAND MI
48642-5860
US

V. Phone/Fax

Practice location:
  • Phone: 989-495-3278
  • Fax:
Mailing address:
  • Phone: 989-495-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: