Organization
KINETIC KIDS, LLC
Active
Organization
KINETIC KIDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN SUE GALLOWAY OTR/L (CEO)
(269) 381-1880
Entity
Organization
Contact information
Practice address
540 EAST MILHAM, PORTAGE, MI 49002
(269) 381-1880
(269) 381-1850
Mailing address
540 EAST MILHAM, PORTAGE, MI 49002
(269) 381-1880
(269) 381-1850
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5201004171
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4719045
—
MI
Enumeration date
04/25/2012
Last updated
04/25/2012
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