Healthcare Provider Details

I. General information

NPI: 1144170762
Provider Name (Legal Business Name): ANNETTE SOPHIE KIELB MOT, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 GROVES DR
STERLING HEIGHTS MI
48310-3629
US

IV. Provider business mailing address

2808 GROVES DR
STERLING HEIGHTS MI
48310-3629
US

V. Phone/Fax

Practice location:
  • Phone: 586-744-5430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: