Kelly Sue Eddy, COTA/L
Individual provider Active NPI Contractor · Saginaw, MI
NPI 1144580986 · NPPES record last updated May 28, 2012
Key facts
- NPI
- 1144580986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 5202004388 (MI)
- Practice address
- 1673 Allendale Dr
Saginaw, MI 48638-4457 - Phone
- (989) 791-7054
- NPI assigned
- May 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5202004388 | MI | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 5202004388 | MI | Yes |
Addresses
Primary practice location
1673 Allendale Dr
Saginaw, MI 48638-4457
Mailing address
1673 Allendale Dr
Saginaw, MI 48638-4457
Phone (989) 791-7054
Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.