Provider Demographics
NPI:1801109558
Name:GRAVES, KELLIE RENAE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:RENAE
Last Name:GRAVES
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 1:32336 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1513
Mailing Address - Country:US
Mailing Address - Phone:248-345-4193
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK EAST DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4316
Practice Address - Country:US
Practice Address - Phone:216-831-4303
Practice Address - Fax:216-831-1032
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist