Healthcare Provider Details

I. General information

NPI: 1356935811
Provider Name (Legal Business Name): OLIVIA TAYLOR HUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STEVENS ST SW
GRAND RAPIDS MI
49507-1526
US

IV. Provider business mailing address

7785 COTTONWOOD DR
JENISON MI
49428-8312
US

V. Phone/Fax

Practice location:
  • Phone: 742-316-6068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: