Provider Demographics
NPI:1760092860
Name:SAKKINEN, KATELYN (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SAKKINEN
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 PERCH ST
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8269
Mailing Address - Country:US
Mailing Address - Phone:248-933-4788
Mailing Address - Fax:
Practice Address - Street 1:830 W LAKE LANSING RD STE 190
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6371
Practice Address - Country:US
Practice Address - Phone:517-333-8533
Practice Address - Fax:517-333-8539
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist