Provider Demographics
NPI:1912283243
Name:KINCAID, JANNIFER A (OTR/L)
Entity Type:Individual
Prefix:
First Name:JANNIFER
Middle Name:A
Last Name:KINCAID
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 1:1516 E BUDER AVE
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1606
Mailing Address - Country:US
Mailing Address - Phone:810-919-5355
Mailing Address - Fax:
Practice Address - Street 1:1516 E BUDER AVE
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1606
Practice Address - Country:US
Practice Address - Phone:810-919-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201008075OtherPROFESSIONAL LICENSE NUMBER