Individual
KELLIE NEWTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6359 E 136TH ST, SAND LAKE, MI 49343-9681
(616) 636-4273
Mailing address
6359 E 136TH ST, SAND LAKE, MI 49343-9681
(616) 636-4273
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202001546
MI
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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