MEDICARE: KAELIN MARIE ROBERTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	5351019321	MI

General Provider Information

NPI Number	:	1457285587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAELIN MARIE ROBERTS

Provider Business Mailing Address
First Line	:	2726 BAYLOR POND CT
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-7420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2726 BAYLOR POND CT
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-7420
Country	:	US
Telephone Number	:	616-460-6993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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Directions to “ KAELIN MARIE ROBERTS ” Practice Location

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