| NPI | 1982931861 |
|---|---|
| Former Name | KELLY JEAN LANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201008913) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: MI 57585) |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2015-04-22 |