Provider Demographics
NPI:1235952946
Name:KUTZLI, ALESHA
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:
Last Name:KUTZLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 16 MILE RD
Mailing Address - Street 2:
Mailing Address - City:KENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49330-9437
Mailing Address - Country:US
Mailing Address - Phone:616-799-2508
Mailing Address - Fax:
Practice Address - Street 1:635 16 MILE RD
Practice Address - Street 2:
Practice Address - City:KENT CITY
Practice Address - State:MI
Practice Address - Zip Code:49330-9437
Practice Address - Country:US
Practice Address - Phone:616-799-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist