Provider Demographics
NPI:1689968562
Name:KEINATH, JYL KIRSTEN
Entity Type:Individual
Prefix:
First Name:JYL
Middle Name:KIRSTEN
Last Name:KEINATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JYL
Other - Middle Name:KIRSTEN
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2402 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3257
Mailing Address - Country:US
Mailing Address - Phone:989-832-2222
Mailing Address - Fax:
Practice Address - Street 1:2203 CANDLESTICK LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3165
Practice Address - Country:US
Practice Address - Phone:989-983-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist