Individual
KELLY JO MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3041 CHARLEVOIX DR SE, GRAND RAPIDS, MI 49546-7035
(616) 942-7200
Mailing address
3041 CHARLEVOIX DR SE, GRAND RAPIDS, MI 49546-7035
(616) 942-7200
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
L1680636
MI
Other
Enumeration date
02/11/2011
Last updated
02/11/2011
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