Provider Demographics
NPI:1912283144
Name:LEWIS-KEATTS, KRISTI MARIE (MHSA, AT, ATC, CFO)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:MARIE
Last Name:LEWIS-KEATTS
Suffix:
Gender:F
Credentials:MHSA, AT, ATC, CFO
Other - Prefix:MISS
Other - First Name:KRISTI
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHSA, AT, ATC
Mailing Address - Street 1:30837 JOY RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7146
Mailing Address - Country:US
Mailing Address - Phone:313-570-8453
Mailing Address - Fax:
Practice Address - Street 1:690 AMSTERDAM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3410
Practice Address - Country:US
Practice Address - Phone:313-938-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
MI26010000312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter