Active NPI
Kendra Ettema, CTRS, MDIV
- Recreation Therapist
- Sterling Heights, MI
National Provider Identifier
1639845357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 59050
- Practice address
- 38257 Mound Rd BLDG D
Sterling Heights, MI 48310-3466 - Phone
- (586) 722-7524
- NPI assigned
- Aug 22, 2021
- Last updated
- Aug 22, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 59050 | MI | Primary |
Addresses
Primary practice location
38257 Mound Rd BLDG D
Sterling Heights, MI 48310-3466
Mailing address
2664 Windsor Dr
Troy, MI 48085-3728
Phone (810) 358-4064
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59050 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629590400000",
"number": "1639845357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2664 WINDSOR DR",
"city": "TROY",
"state": "MI",
"postal_code": "480853728",
"telephone_number": "810-358-4064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38257 MOUND RD BLDG D",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483103466",
"telephone_number": "586-722-7524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTEMA",
"first_name": "KENDRA",
"credential": "CTRS, MDIV",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-22",
"last_updated": "2021-08-22",
"certification_date": "2021-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MI",
"license": "59050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sterling Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.