Individual
MRS. KELLY JEAN VIRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS, MOT OTRL
Contact information
Practice address
41521 W 11 MILE RD, NOVI, MI 48375-1803
(248) 299-0030
Mailing address
2274 GEYER CT, LAKE ORION, MI 48360
(586) 383-0594
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
57585
MI
225X00000X
Occupational Therapist
Primary
5201008913
MI
Other
Enumeration date
11/12/2009
Last updated
04/22/2015
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