Healthcare Provider Details

I. General information

NPI: 1689262834
Provider Name (Legal Business Name): KAITLYN THAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 FORT ST
TRENTON MI
48183-2003
US

IV. Provider business mailing address

31153 PLYMOUTH RD STE 105
LIVONIA MI
48150-2134
US

V. Phone/Fax

Practice location:
  • Phone: 734-304-4159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6852094490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: