Provider Demographics
NPI:1538832662
Name:CHAMBERS, KIRSTEN AVERY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:AVERY
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17870 PETUNIA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-8775
Mailing Address - Country:US
Mailing Address - Phone:734-546-7663
Mailing Address - Fax:
Practice Address - Street 1:639 OAK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5024
Practice Address - Country:US
Practice Address - Phone:734-759-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist