Healthcare Provider Details

I. General information

NPI: 1376467324
Provider Name (Legal Business Name): ALLISON NOELLE BAMMERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 E CLARK RD STE 360-A
DEWITT MI
48820-7930
US

IV. Provider business mailing address

5339 WOODMONT DR
PORTAGE MI
49002-0544
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-5525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014755
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: