| Doctor Name: | KELSEY OTTERBEIN |
| NPI Number: | 1306235569 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 5601007272 |
| Business Practice Address: | 743 E Beltline Ave Ne Grand Rapids, MI - 495256045 |
| Business Phone Number: | 6164569553 |
| Business Fax Number: | 6164545371 |
| Mailing Address: | 743 E Beltline Ave Ne, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495256045 |
| Phone Number: | 6164569553 |
| Fax Number: | 6164545371 |
| NPI Enumeration Date: | 01/12/2015 |
| NPI Last Update Date: | 01/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5601007272 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |