Individual
KELSEY BANACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
15063 GRATIOT AVE, DETROIT, MI 48205-1332
(313) 372-4065
Mailing address
68050 HARTWAY RD, RAY, MI 48096-1433
(586) 623-2986
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201008857
MI
Other
Enumeration date
06/03/2014
Last updated
06/03/2014
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