Provider Demographics
NPI:1235323767
Name:BREIMAYER, KRISTEN D (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:BREIMAYER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:D
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR
Mailing Address - Street 1:6604 BELLA VISTA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8441
Mailing Address - Country:US
Mailing Address - Phone:734-748-7144
Mailing Address - Fax:734-748-7144
Practice Address - Street 1:2251 EAST PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2431
Practice Address - Country:US
Practice Address - Phone:616-447-7799
Practice Address - Fax:616-447-7799
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2679020Medicaid
MI30435OtherBLUE CROSS BLUE SHIELD
23-6584Medicare PIN