Healthcare Provider Details

I. General information

NPI: 1265005151
Provider Name (Legal Business Name): HOME CONNECTION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 GRISWOLD ST SE
GRAND RAPIDS MI
49507-3815
US

IV. Provider business mailing address

1232 GRISWOLD ST SE
GRAND RAPIDS MI
49507-3815
US

V. Phone/Fax

Practice location:
  • Phone: 616-890-8660
  • Fax:
Mailing address:
  • Phone: 616-890-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN VANDERLAAN
Title or Position: MANAGING MEMBER / OWNER
Credential: MS, OTR/L, CCM
Phone: 616-890-8660