Provider Demographics
NPI:1669432738
Name:GEORGE, KELLIE KAY (ATC)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:KAY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-8437
Mailing Address - Country:US
Mailing Address - Phone:248-505-0710
Mailing Address - Fax:
Practice Address - Street 1:902 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48550-0001
Practice Address - Country:US
Practice Address - Phone:810-236-5198
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer