Provider Demographics
NPI:1245442664
Name:KUTNICK, MARGARET BECKSTROM (OTR)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:BECKSTROM
Last Name:KUTNICK
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 1:45441 EMBASSY CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1540
Mailing Address - Country:US
Mailing Address - Phone:734-453-0335
Mailing Address - Fax:
Practice Address - Street 1:2100 E PROVINCIAL HOUSE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4884
Practice Address - Country:US
Practice Address - Phone:517-882-2458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003315225X00000X
NM2338225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist