Healthcare Provider Details

I. General information

NPI: 1831964964
Provider Name (Legal Business Name): EMILY KAWUKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 BOSTON ST SE
GRAND RAPIDS MI
49506-4185
US

IV. Provider business mailing address

2454 MILLVIEW
ZEELAND MI
49464-8368
US

V. Phone/Fax

Practice location:
  • Phone: 616-245-9179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: