Active NPI
Kelly Jean Mahla, LLP, PTA
- Massage Therapist
- Macomb, MI
National Provider Identifier
1356551824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 55753 Serene Dr
Macomb, MI 48042-6164 - Phone
- (586) 216-3815
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301013552 | MI | |
| Massage Therapist | 225700000X | Primary |
Addresses
Primary practice location
55753 Serene Dr
Macomb, MI 48042-6164
Mailing address
55753 Serene Dr
Macomb, MI 48042-6164
Phone (586) 216-3815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013552 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353283200000",
"number": "1356551824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55753 SERENE DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480426164",
"telephone_number": "586-216-3815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55753 SERENE DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480426164",
"telephone_number": "586-216-3815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHLA",
"first_name": "KELLY",
"middle_name": "JEAN",
"name_prefix": "Miss",
"credential": "LLP, PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2012-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301013552",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.