MEDICARE: HOME CONNECTION THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265005151	OTHER	MI	GROUP NPI

General Provider Information

NPI Number	:	1265005151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CONNECTION THERAPY LLC

Provider Business Mailing Address
First Line	:	1232 GRISWOLD ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3815
Country	:	US
Telephone Number	:	616-890-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 GRISWOLD ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3815
Country	:	US
Telephone Number	:	616-890-8660
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER / OWNER
Name	:	LAUREN VANDERLAAN
Credential	:	MS, OTR/L, CCM
Telephone Number	:	616-890-8660

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	08/23/2024

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Directions to “HOME CONNECTION THERAPY LLC ” Practice Location

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