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NPI Code Detail

MEDICARE: KEELY-SHAYE LONSBURY

MEDICARE: KEELY-SHAYE LONSBURY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1114709169
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEELY-SHAYE LONSBURY
Provider Business Mailing Address
First Line : 11660 CHIPPEWA HWY
Second Line :
City : BEAR LAKE
State : MI
Zip : 49614-9419
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11660 CHIPPEWA HWY
Second Line :
City : BEAR LAKE
State : MI
Zip : 49614-9419
Country : US
Telephone Number : 231-655-3146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2023
Last Update Date : 10/16/2023

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Directions to “ KEELY-SHAYE LONSBURY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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