1982931861 NPI number — MRS. KELLY JEAN VIRES MOT OTRL

Table of content: MRS. KELLY JEAN VIRES MOT OTRL (NPI 1982931861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982931861 NPI number — MRS. KELLY JEAN VIRES MOT OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIRES
Provider First Name:
KELLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MOT OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANE
Provider Other First Name:
KELLY
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOT, OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982931861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1154 RIDGEVIEW CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48362-3452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-383-0594
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52585 DEQUINDRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-726-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5201008913 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)