Provider Demographics
NPI:1407904527
Name:PAQUET, KELLY A (ATC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:PAQUET
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 ALWARD RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9244
Mailing Address - Country:US
Mailing Address - Phone:517-651-7223
Mailing Address - Fax:
Practice Address - Street 1:1720 ABBEY RD
Practice Address - Street 2:STE. A
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6363
Practice Address - Country:US
Practice Address - Phone:517-333-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer