Individual
MARY KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19401 NORTHLINE RD, SOUTHGATE, MI 48195-2277
(734) 785-7718
Mailing address
1394 PHILOMENE BLVD, LINCOLN PARK, MI 48146-2315
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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