Provider Demographics
NPI:1811165525
Name:HALE, KELLY (OT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1185 S ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7101
Mailing Address - Country:US
Mailing Address - Phone:248-988-8098
Mailing Address - Fax:248-988-8583
Practice Address - Street 1:1185 S ADAMS RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7101
Practice Address - Country:US
Practice Address - Phone:248-988-8098
Practice Address - Fax:248-988-8583
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist