Provider Demographics
NPI:1154799666
Name:KLEIS, MARY LYNNE (OTR/L, CHT, CLT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNNE
Last Name:KLEIS
Suffix:
Gender:F
Credentials:OTR/L, CHT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9733
Mailing Address - Country:US
Mailing Address - Phone:616-669-2734
Mailing Address - Fax:616-669-2734
Practice Address - Street 1:3739 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9733
Practice Address - Country:US
Practice Address - Phone:616-669-2734
Practice Address - Fax:616-669-2734
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001229225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790157097Medicaid
MI0G00491OtherBCBSM
MI1790157097Medicaid
MI0G00491OtherBCBSM
MI748169001Medicare PIN