Kelly Jo Maxwell

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

L1680636 Issued in MI

Practice address

3041 Charlevoix Dr SE
Grand Rapids, MI 49546-7035

Phone

(616) 942-7200

NPI assigned

Feb 11, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297382400000",
    "number": "1295032142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 CHARLEVOIX DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467035",
            "telephone_number": "616-942-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3041 CHARLEVOIX DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467035",
            "telephone_number": "616-942-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "KELLY",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-11",
        "last_updated": "2011-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "L1680636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxim Healthcare Services, Inc.
• Judith Ann Maxim, RN
• Maxwell Taylor
• Breeyn Nicole Maxwell, MA, LPC, CAADC
• Casilda Maxwell, PHD
• Erin May-Batchelor, MA LLP LPC CAADC
• Angel May
• Brett A May, PH.D.
• Denise Kelly May
• Joshua May

• All providers in Grand Rapids, MI
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.