Provider Demographics
NPI:1053674333
Name:KELLAR, AMANDA L (DAC, LAC, DIP AC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:KELLAR
Suffix:
Gender:F
Credentials:DAC, LAC, DIP AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7144 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1505
Mailing Address - Country:US
Mailing Address - Phone:248-931-6606
Mailing Address - Fax:
Practice Address - Street 1:7144 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-931-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000051171100000X
MI5402000007171100000X
OH65.000238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist