Provider Demographics
NPI:1164298386
Name:WILLEY, KRISTIN SABIN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:SABIN
Last Name:WILLEY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 PEREGRINE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9723
Mailing Address - Country:US
Mailing Address - Phone:616-643-0833
Mailing Address - Fax:
Practice Address - Street 1:3152 PEREGRINE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9723
Practice Address - Country:US
Practice Address - Phone:616-643-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5291994729225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics