Provider Demographics
NPI:1831473875
Name:LEWIS, KELLY MICHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-8684
Mailing Address - Country:US
Mailing Address - Phone:269-267-7097
Mailing Address - Fax:269-447-2191
Practice Address - Street 1:11935 E MN AVE
Practice Address - Street 2:
Practice Address - City:CLIMAX
Practice Address - State:MI
Practice Address - Zip Code:49034-9721
Practice Address - Country:US
Practice Address - Phone:269-267-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006821225X00000X, 225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision