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NPI Code Detail

MEDICARE: MARIE LOUISE DENHERDER OTR

MEDICARE: MARIE LOUISE DENHERDER OTR
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
1225X00000XOccupational Therapist5201001552MI

General Provider Information

NPI Number : 1619183464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE LOUISE DENHERDER OTR
Provider Business Mailing Address
First Line : 862 PINNACLE RUN DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8342
Country : US
Telephone Number : 616-956-6818
Fax Number :
Provider Business Practice Location Address
First Line : 2161 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3829
Country : US
Telephone Number : 616-453-7715
Fax Number : 616-735-0633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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