Provider Demographics
NPI:1225834302
Name:NIEMAN, KRISTIN FAITH (OTRL)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:FAITH
Last Name:NIEMAN
Suffix:
Gender:
Credentials:OTRL
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:FAITH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13000 BURMA HWY
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-9513
Mailing Address - Country:US
Mailing Address - Phone:734-790-0971
Mailing Address - Fax:
Practice Address - Street 1:200 SAND CREEK HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1255
Practice Address - Country:US
Practice Address - Phone:517-263-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201014157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist