MEDICARE: KRISTEN NESBURG

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1972091882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NESBURG

Provider Business Mailing Address
First Line	:	7460 ELLEN RD
Second Line	:
City	:	ONEKAMA
State	:	MI
Zip	:	49675-9715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 S MITCHELL ST
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-2510
Country	:	US
Telephone Number	:	231-876-6900
Fax Number	:

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

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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Directions to “ KRISTEN NESBURG ” Practice Location

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