Individual
KASSIDY LYN ROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
200 SAND CREEK HWY, ADRIAN, MI 49221-1255
(517) 263-6794
Mailing address
363 ALFORD RD, DUNDEE, MI 48131-9725
(734) 497-7165
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
5201013038
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861488108
—
MI
Enumeration date
08/01/2022
Last updated
08/01/2022
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