Healthcare Provider Details

I. General information

NPI: 1093284663
Provider Name (Legal Business Name): KATHRYN DANIELLE LAFRINERE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

23701 TALBOT ST
SAINT CLAIR SHORES MI
48082-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9610
  • Fax:
Mailing address:
  • Phone: 231-420-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: