Provider Demographics
NPI:1669219028
Name:UKAUKA, KRISTY DEANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:DEANNE
Last Name:UKAUKA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S LINWOOD BEACH RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-9432
Mailing Address - Country:US
Mailing Address - Phone:805-233-5702
Mailing Address - Fax:
Practice Address - Street 1:7110 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9310
Practice Address - Country:US
Practice Address - Phone:989-560-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist