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General NPI Number Information
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NPI Number | 1215232806
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Entity Type | Individual
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Provider Name | KELLY MICHELLE WEIR AT, ATC, PES, CSCS
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Gender | Female
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 39450 W 12 MILE RD
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City | NOVI
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State | MI
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Zip | 48377-3600
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Country | US
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Telephone | 248-344-2300
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Fax | 248-344-2301
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Provider Business Mailing Address
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Address Line | 1418 SUNSET DR
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City | WOLVERINE LAKE
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State | MI
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Zip | 48390-2348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601000294
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License Number State | MI
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