Healthcare Provider Details

I. General information

NPI: 1467362111
Provider Name (Legal Business Name): KAITLEN KINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52585 DEQUINDRE RD
ROCHESTER HILLS MI
48307-2321
US

IV. Provider business mailing address

3152 CURTIS RD
LEONARD MI
48367-2101
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-6894
  • Fax:
Mailing address:
  • Phone: 586-817-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201010500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: