Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mitten State Pediatric Therapy LLC

Organization Pediatric Rehabilitation Medicine Physician · NPI 1063021715

Mitten State Pediatric Therapy LLC is a Pediatric Rehabilitation Medicine Physician in Grand Rapids, Michigan. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5258 Plainfield Ave NE Ste A
Grand Rapids, MI 49525-1092
Phone: (616) 466-4068
Fax: (616) 369-1646
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X
Pediatric Rehabilitation Medicine Physician Taxonomy 2081P0010X
Physical Therapist Taxonomy 225100000X
Speech-Language Pathologist Taxonomy 235Z00000X

Record details

NPI number1063021715
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lindsay Dammar — Co-Owner · (248) 535-4666
NPI enumeratedJuly 29, 2020
Last updated in NPPESSeptember 11, 2023
Certification dateSeptember 11, 2023
Mailing address6659 Craftsman Square Dr Ne, Rockford, MI 49341-8861

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