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General NPI Number Information
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NPI Number | 1568916930
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Entity Type | Individual
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Provider Name | KELLY ANN STETSER MS, AT, ATC, CEIS
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Gender | Female
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 725 E MAIN AVE
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City | ZEELAND
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State | MI
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Zip | 49464-1331
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Country | US
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Telephone | 616-748-7234
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Fax | 616-748-7033
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Provider Business Mailing Address
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Address Line | 4182 PINE CREEK RD SW APT 4
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City | GRANDVILLE
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State | MI
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Zip | 49418-2528
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Country | US
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Telephone | 248-217-4565
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Fax | 616-748-7033
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | S332465067653
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License Number State | MI
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