Kyle Medearis, MS OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201008742 Issued in MI

Practice address

415 Munson Ave Ste 101
Traverse City, MI 49686-3059

Phone

(231) 486-6330

NPI assigned

Dec 2, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Level Eleven Saginaw, LLC

  • Rehabilitation Clinic/Center
  • Saginaw, MI
  • NPI 1164201679
  NPD

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524009600000",
    "number": "1780081075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MUNSON AVE STE 101",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MUNSON AVE STE 101",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863059",
            "telephone_number": "231-486-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEARIS",
        "first_name": "KYLE",
        "credential": "MS OTRL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-02",
        "last_updated": "2018-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201008742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487087300",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "MI7576007",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Marie McQuestion
• Allen W McSweeney, MSW
• Sandra McSweeney, RD
• John Meacham Mead, RN, BSN, LLMSW
• Timothy Michael Meagher, MA, LLP
• Margaret J Meeker, M.D.
• Walter K Meeker, M.D.
• Mary Terese Meernik, O.D.
• Karan D Mehta, MD
• Jayea L Meihls

• Occupational Therapist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; 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.