Healthcare Provider Details

I. General information

NPI: 1881559342
Provider Name (Legal Business Name): ROOTS PEDIATRIC OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 STONE DR
GREENBACK TN
37742-4121
US

IV. Provider business mailing address

673 STONE DR
GREENBACK TN
37742-4121
US

V. Phone/Fax

Practice location:
  • Phone: 517-795-4859
  • Fax:
Mailing address:
  • Phone: 517-795-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMBER KAPNICK
Title or Position: OWNER
Credential: MS, OTR/L
Phone: 517-795-4859