Healthcare Provider Details

I. General information

NPI: 1932969938
Provider Name (Legal Business Name): JAMES CONOR MCKELVEY OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 E 10 MILE RD
WARREN MI
48089-3903
US

IV. Provider business mailing address

3268 CATALPA DR
BERKLEY MI
48072-1249
US

V. Phone/Fax

Practice location:
  • Phone: 586-353-3800
  • Fax:
Mailing address:
  • Phone: 248-990-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201013824
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: