Healthcare Provider Details

I. General information

NPI: 1063350577
Provider Name (Legal Business Name): KATHLEEN WESTRA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 HEALTH PKWY
PAW PAW MI
49079-8242
US

IV. Provider business mailing address

451 HEALTH PKWY
PAW PAW MI
49079-8242
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201000714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: