Provider Demographics
NPI:1598126047
Name:LAMPHERE, KAITLYN MICHELE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MICHELE
Last Name:LAMPHERE
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 COVE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1383
Mailing Address - Country:US
Mailing Address - Phone:616-847-1280
Mailing Address - Fax:616-847-1290
Practice Address - Street 1:17001 FERRIS ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9441
Practice Address - Country:US
Practice Address - Phone:616-850-6033
Practice Address - Fax:616-850-6011
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010016442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer