Provider Demographics
NPI:1386208627
Name:COUTURE, KRISTEN C (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:C
Last Name:COUTURE
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 1:1020 WATERSEDGE CT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3688
Mailing Address - Country:US
Mailing Address - Phone:248-210-9203
Mailing Address - Fax:
Practice Address - Street 1:2975 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3786
Practice Address - Country:US
Practice Address - Phone:248-645-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist