Kayla Vandenboom, CTRS
Individual provider Active NPI Recreation Therapist · Reese, MI
NPI 1720522121 · NPPES record last updated Dec 5, 2016
Key facts
- NPI
- 1720522121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Recreation Therapist 225800000X
- License
- 59652 (MI)
- Practice address
- 9948 Center St
Reese, MI 48757-9547 - Phone
- (989) 297-0042
- NPI assigned
- Dec 5, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59652 | MI | MD | Recreation Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 59652 | MI | Yes |
Addresses
Primary practice location
9948 Center St
Reese, MI 48757-9547
Mailing address
9948 Center St
Reese, MI 48757-9547
Other providers in Reese, MI
- Saginaw Physical Therapy and Rehab Specialists LLC
- Saginaw Physical Therapy and Rehab Specialists LLC
- Scott C McDougall DO LLC
- Tyler Simpson
- Lacy Ann Torrez
All providers in Reese, MI · Recreation Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.