Individual
MRS. KATHLEEN MARIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
512 BEACH ST, FENTON, MI 48430-3122
(810) 629-4117
Mailing address
11182 E RICHFIELD RD, DAVISON, MI 48423-8517
(810) 252-9888
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
5502001225
MI
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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