Provider Demographics
NPI:1497149124
Name:ELY, KARIANNE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:KARIANNE
Middle Name:
Last Name:ELY
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92407 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-8850
Mailing Address - Country:US
Mailing Address - Phone:269-462-5352
Mailing Address - Fax:
Practice Address - Street 1:92407 CENTER DR
Practice Address - Street 2:
Practice Address - City:DOWAGAIC
Practice Address - State:MI
Practice Address - Zip Code:49047
Practice Address - Country:US
Practice Address - Phone:269-462-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer