Provider Demographics
NPI:1285857243
Name:DUNNING, KATHLEEN ANN (OTR)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:DUNNING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 ROCHESTER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5422
Mailing Address - Country:US
Mailing Address - Phone:248-689-0468
Mailing Address - Fax:248-689-1068
Practice Address - Street 1:3190 ROCHESTER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5422
Practice Address - Country:US
Practice Address - Phone:248-689-0468
Practice Address - Fax:248-689-1068
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist