Provider Demographics
NPI:1154090975
Name:STEPANSKI, KELLY CHRISTINE (OTRL)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:STEPANSKI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15242 WELLER CT
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1030
Mailing Address - Country:US
Mailing Address - Phone:810-626-3953
Mailing Address - Fax:
Practice Address - Street 1:15242 WELLER CT
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1030
Practice Address - Country:US
Practice Address - Phone:810-626-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist