Provider Demographics
NPI:1982090593
Name:STORY, KERI L (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:STORY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7295 MILAN DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3051
Mailing Address - Country:US
Mailing Address - Phone:989-413-2685
Mailing Address - Fax:
Practice Address - Street 1:1908 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1232
Practice Address - Country:US
Practice Address - Phone:269-459-6212
Practice Address - Fax:269-585-6068
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist