Doctor Name: | KELLY LANG GRAHAM |
NPI Number: | 1235482142 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | OTR/L |
License Number: | L 2309842 |
Business Practice Address: | 2075 E West Maple Rd Ste B-204 Commerce Township, MI - 483903816 |
Business Phone Number: | 2489260909 |
Business Fax Number: | |
Mailing Address: | 27530 Roan Dr, WARREN |
State: | MI |
Postal Code: | 480934614 |
Phone Number: | 5862558519 |
Fax Number: | |
NPI Enumeration Date: | 10/17/2012 |
NPI Last Update Date: | 10/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | L 2309842 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |