Provider Demographics
NPI:1629591482
Name:FABUS, KALEY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:ANN
Last Name:FABUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:ANN
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:131 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2369
Practice Address - Country:US
Practice Address - Phone:313-948-8769
Practice Address - Fax:313-948-8769
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist