Provider Demographics
NPI:1699068361
Name:COVIAK, KELLEE ANN (MT-BC)
Entity type:Individual
Prefix:MS
First Name:KELLEE
Middle Name:ANN
Last Name:COVIAK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81003
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48908-1003
Mailing Address - Country:US
Mailing Address - Phone:517-862-4675
Mailing Address - Fax:
Practice Address - Street 1:3218 PREAKNESS WAY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-9093
Practice Address - Country:US
Practice Address - Phone:517-862-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist