Kassidy Lyn Roe, OTD, OTR/L

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

5201013038 Issued in MI

Practice address

200 Sand Creek Hwy
Adrian, MI 49221-1255

Phone

(517) 263-6794

NPI assigned

Aug 1, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1093442014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 ALFORD RD",
            "city": "DUNDEE",
            "state": "MI",
            "postal_code": "481319725",
            "telephone_number": "734-497-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SAND CREEK HWY",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211255",
            "telephone_number": "517-263-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "KASSIDY",
        "middle_name": "LYN",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "MI",
            "license": "5201013038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861488108",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kassidy.roe@rockets.utoledo.edu",
            "affiliation": "N",
            "address_1": "200 Sand Creek Hwy",
            "city": "Adrian",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492211255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lorie Robinette, MS, LAT, ATC
• Kelly Roby, PT, DPT
• Mark M Rodan, MSW
• Jada Rodriguez-Wagner, LLPC
• Ellen Michaela Rodriguez, LLMSW
• Roxanne Roe
• Torri Len Rogers, CNP
• Samantha Lynn Roopas
• Lupe John Rosas
• Kristin Patrice Ross, DDS

• Gerontology Occupational Therapist in Adrian, MI
• Providers in Adrian, MI by specialty
• Gerontology Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.