Provider Demographics
NPI:1003676628
Name:VARGO, KAITLIN MEGAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MEGAN
Last Name:VARGO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MEGAN
Other - Last Name:KIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:48722 SUGARBUSH RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34901 DIVISION RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1559
Practice Address - Country:US
Practice Address - Phone:586-727-7562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007993224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant