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Individual

KELSEY KING

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MOT, OTR/L

Contact information

Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
4240 CASS AVE APT 201, DETROIT, MI 48201-1970
(248) 885-6048

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201009938
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5201009938
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
02/21/2018
Last updated
03/18/2021
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