Provider Demographics
NPI:1063761039
Name:DYER, KATRINA (OTR/L)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:STANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 N CEDAR ST
Mailing Address - Street 2:APT 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1219
Mailing Address - Country:US
Mailing Address - Phone:231-250-6300
Mailing Address - Fax:
Practice Address - Street 1:2111 MERRITT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6916
Practice Address - Country:US
Practice Address - Phone:517-332-3232
Practice Address - Fax:517-332-1132
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008216225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist