Healthcare Provider Details

I. General information

NPI: 1659045284
Provider Name (Legal Business Name): KYLEE PAGE CHURCH MS, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 DEVELOPMENT DR
LANSING MI
48911-4213
US

IV. Provider business mailing address

311 W BROAD ST
EATON RAPIDS MI
48827-1410
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-0421
  • Fax: 517-706-0423
Mailing address:
  • Phone: 517-643-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201014415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: