Healthcare Provider Details

I. General information

NPI: 1982154035
Provider Name (Legal Business Name): KENDRA LEIGH KERBS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MONROE AVE NW SUITE 110
GRAND RAPIDS MI
49505-4680
US

IV. Provider business mailing address

355 UNION AVE SE
GRAND RAPIDS MI
49503-4720
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-2905
  • Fax: 616-333-2321
Mailing address:
  • Phone: 616-795-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201009539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: