Healthcare Provider Details

I. General information

NPI: 1104733997
Provider Name (Legal Business Name): KAILEE MOSHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25425 TAFT RD
NOVI MI
48374-2424
US

IV. Provider business mailing address

311 STEVENS DR APT 203
YPSILANTI MI
48197-4535
US

V. Phone/Fax

Practice location:
  • Phone: 734-717-3804
  • Fax:
Mailing address:
  • Phone: 734-717-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014302
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: