Provider Demographics
NPI:1447602263
Name:MEYERDIRK, KRISTIN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MEYERDIRK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DEWENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6610 CROWN POINT DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9014
Mailing Address - Country:US
Mailing Address - Phone:616-425-1858
Mailing Address - Fax:
Practice Address - Street 1:6610 CROWN POINT DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9014
Practice Address - Country:US
Practice Address - Phone:616-425-1858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007977224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant