Healthcare Provider Details

I. General information

NPI: 1669219028
Provider Name (Legal Business Name): KRISTY DEANNE UKAUKA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 MICHIGAN RD
BAY CITY MI
48706-9310
US

IV. Provider business mailing address

541 S LINWOOD BEACH RD
LINWOOD MI
48634-9432
US

V. Phone/Fax

Practice location:
  • Phone: 989-560-0846
  • Fax:
Mailing address:
  • Phone: 805-233-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013792
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: