Provider Demographics
NPI:1841568987
Name:SEELYE, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SEELYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 W CENTRE AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4664
Mailing Address - Country:US
Mailing Address - Phone:269-207-3626
Mailing Address - Fax:
Practice Address - Street 1:4024 W CENTRE AVE APT 118
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4664
Practice Address - Country:US
Practice Address - Phone:269-207-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist