Healthcare Provider Details

I. General information

NPI: 1386556942
Provider Name (Legal Business Name): MARIAH PLETZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6284 BELMONT AVE NE
BELMONT MI
49306-9534
US

IV. Provider business mailing address

3911 WIERENGOS WAY CT NE
ROCKFORD MI
49341-9196
US

V. Phone/Fax

Practice location:
  • Phone: 616-951-1077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: