Provider Demographics
NPI:1679168256
Name:ROOTS AND WINGS THERAPIES
Entity type:Organization
Organization Name:ROOTS AND WINGS THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RUGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:269-443-2342
Mailing Address - Street 1:3901 EMERALD DR STE D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-7923
Mailing Address - Country:US
Mailing Address - Phone:269-443-2342
Mailing Address - Fax:269-743-2420
Practice Address - Street 1:3901 EMERALD DR STE D
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-7923
Practice Address - Country:US
Practice Address - Phone:269-443-2342
Practice Address - Fax:269-743-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty