Healthcare Provider Details

I. General information

NPI: 1497360242
Provider Name (Legal Business Name): KEELY ERIN RHIANNON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEELY ZURI PTA

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 W. BIG BEAVER
TROY MI
48084
US

IV. Provider business mailing address

311 N WASHINGTON ST
YPSILANTI MI
48197-2521
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-3633
  • Fax: 248-281-0515
Mailing address:
  • Phone: 810-288-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851117681
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005903
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: