Healthcare Provider Details

I. General information

NPI: 1114428190
Provider Name (Legal Business Name): KYLE HARBIN MBA, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 DOBIE RD
OKEMOS MI
48864-3953
US

IV. Provider business mailing address

818 N EAST ST
EATON RAPIDS MI
48827-9238
US

V. Phone/Fax

Practice location:
  • Phone: 517-381-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201006918
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: