Healthcare Provider Details

I. General information

NPI: 1760711311
Provider Name (Legal Business Name): KATHRYN ANNE OBERLE CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 PARKER AVE
KALAMAZOO MI
49008-3141
US

IV. Provider business mailing address

925 PARKER AVE
KALAMAZOO MI
49008-3141
US

V. Phone/Fax

Practice location:
  • Phone: 269-532-1470
  • Fax: 269-532-1472
Mailing address:
  • Phone: 269-532-1470
  • Fax: 269-532-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number54720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: