Healthcare Provider Details

I. General information

NPI: 1124931753
Provider Name (Legal Business Name): LIANNA REATINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 OAKRIDGE AVE NW
COMSTOCK PARK MI
49321-9004
US

IV. Provider business mailing address

125 LURAY AVE NW
GRAND RAPIDS MI
49504-5940
US

V. Phone/Fax

Practice location:
  • Phone: 616-254-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: