Provider Demographics
NPI:1912482316
Name:RIBANT, KATLYN ELIZABETH (OTR)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:RIBANT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:ELIZABETH
Other - Last Name:RIBANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 SUNSET HILLS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-5842
Mailing Address - Country:US
Mailing Address - Phone:616-745-2925
Mailing Address - Fax:
Practice Address - Street 1:2708 MEYER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2333
Practice Address - Country:US
Practice Address - Phone:616-855-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2022-01-11
Deactivation Date:2021-10-04
Deactivation Code:
Reactivation Date:2021-10-18
Provider Licenses
StateLicense IDTaxonomies
MI5202008302224Z00000X
MI5201011421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant