Most Relevant Information
Provider Data
| NPI Number: | 1003458423 |
| Provider Name: | KELLY LYNN OUELLETTE OT |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 5201010533 |
Most Important Dates
| Enumeration Date: | 10/17/2019 |
| Last Updated: | 10/17/2019 |
Provider Practice Location
15100 WHITTAKER WAY
GRAND HAVEN
MI
494178696
Practice Location Phone/Fax
| Phone: | 6169356280 |
| Fax: |
Provider Mailing Location
100 MICHIGAN ST NE # MC845
GRAND RAPIDS
MI
495032560
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |