Provider Demographics
NPI:1306069638
Name:KOBER, KRISTINE KAY (OTR)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:KAY
Last Name:KOBER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:KRISTINE
Other - Middle Name:KAY
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:642 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1258
Mailing Address - Country:US
Mailing Address - Phone:616-822-0703
Mailing Address - Fax:
Practice Address - Street 1:642 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1258
Practice Address - Country:US
Practice Address - Phone:616-822-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP29110Medicare ID - Type Unspecified