Individual
KYLE BLICKENSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S.
Contact information
Practice address
2700 E LANSING DR, EAST LANSING, MI 48823-7754
(517) 332-1616
Mailing address
2700 E LANSING DR, EAST LANSING, MI 48823-7754
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
06/02/2016
Last updated
06/02/2016
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