Healthcare Provider Details

I. General information

NPI: 1982513255
Provider Name (Legal Business Name): KIMBERLY LYNN MARTUS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 WING LAKE RD
BLOOMFIELD HILLS MI
48301-1538
US

IV. Provider business mailing address

6490 WING LAKE RD
BLOOMFIELD HILLS MI
48301-1538
US

V. Phone/Fax

Practice location:
  • Phone: 248-341-5400
  • Fax:
Mailing address:
  • Phone: 248-341-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201007090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: