Individual
KYLE MEDEARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS OTRL
Contact information
Practice address
415 MUNSON AVE STE 101, TRAVERSE CITY, MI 49686-3059
(231) 486-6330
Mailing address
415 MUNSON AVE STE 101, TRAVERSE CITY, MI 49686-3059
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201008742
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487087300
NPI
—
01
—
MI7576007
MEDICARE
—
Enumeration date
12/02/2014
Last updated
04/18/2018
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