Provider Demographics
NPI:1912018037
Name:PERRIN, KIMBERLEY ROSE (MA, OTR/L, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:ROSE
Last Name:PERRIN
Suffix:
Gender:F
Credentials:MA, OTR/L, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51145 NICOLETTE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4585
Mailing Address - Country:US
Mailing Address - Phone:586-228-9991
Mailing Address - Fax:
Practice Address - Street 1:51145 NICOLETTE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4585
Practice Address - Country:US
Practice Address - Phone:586-228-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000601103K00000X
MI5201005018225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist