MEDICARE: LEANN REDMAN-WHEELER PHD, CTRS

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	225800000X	Recreation Therapist	63405	MI

General Provider Information

NPI Number	:	1730863457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANN REDMAN-WHEELER PHD, CTRS

Provider Business Mailing Address
First Line	:	310 N FRONT
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9307
Country	:	US
Telephone Number	:	231-944-5776
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 N FRONT
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9307
Country	:	US
Telephone Number	:	231-944-5776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2023
Last Update Date	:	06/13/2023

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