Individual
KELLY MICHELE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT
Contact information
Practice address
300 W MAIN ST APT 2B, SPRINGPORT, MI 49284-9517
(517) 214-9511
(517) 214-9511
Mailing address
300 W MAIN ST, SPRINGPORT, MI 49284-9517
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225A2300X
ATHLETIC TRAINER
MI
Enumeration date
08/02/2017
Last updated
06/16/2018
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