Provider Demographics
NPI:1558592378
Name:SCHURING, KELLY (OT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:SCHURING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:VANDYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:900 PEELER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2300
Mailing Address - Country:US
Mailing Address - Phone:269-345-8618
Mailing Address - Fax:269-345-1508
Practice Address - Street 1:7920 KIRKLAND CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4974
Practice Address - Country:US
Practice Address - Phone:269-381-7246
Practice Address - Fax:269-345-5354
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005096225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201005096OtherMI OCCUPATIONAL THERAPIST LICENSE