Provider Demographics
NPI:1023541224
Name:RUHLACH, KELLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RUHLACH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HELSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9910 TUTTLEHILL RD
Mailing Address - Street 2:
Mailing Address - City:MAYBEE
Mailing Address - State:MI
Mailing Address - Zip Code:48159-9795
Mailing Address - Country:US
Mailing Address - Phone:507-210-8045
Mailing Address - Fax:
Practice Address - Street 1:1055 CORNELL RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1657
Practice Address - Country:US
Practice Address - Phone:734-487-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist