Basic Information
| Provider Information | |||||||||
| NPI: | 1316425457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARNEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8551 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483175360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5868542227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 873 W AVON RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483072705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486563239 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2018 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201007457 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.