Healthcare Provider Details

I. General information

NPI: 1346986643
Provider Name (Legal Business Name): KAITLYN OATES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W 8TH ST
MIO MI
48647-9140
US

IV. Provider business mailing address

PO BOX 93
MIO MI
48647-0093
US

V. Phone/Fax

Practice location:
  • Phone: 989-785-4855
  • Fax: 989-318-4606
Mailing address:
  • Phone: 989-335-3690
  • Fax: 989-286-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: