Individual
KELLY COUSINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
4646 JOHN R ST RM A5109, DETROIT, MI 48201-1916
(313) 576-1217
Mailing address
4646 JOHN R ST RM A5109, DETROIT, MI 48201-1916
(133) 576-1217
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
03/02/2007
Last updated
11/03/2021
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