Provider Demographics
NPI:1982584249
Name:FLORES, KELSEY (COTA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:FIBRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13308 THORNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8844
Mailing Address - Country:US
Mailing Address - Phone:989-670-6283
Mailing Address - Fax:
Practice Address - Street 1:219 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1431
Practice Address - Country:US
Practice Address - Phone:810-412-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202010248224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant