Healthcare Provider Details

I. General information

NPI: 1518635028
Provider Name (Legal Business Name): JOSEPHINE ROSE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 3 MILE RD NW STE J
GRAND RAPIDS MI
49544-1650
US

IV. Provider business mailing address

1000 3 MILE RD NW STE J
GRAND RAPIDS MI
49544-1650
US

V. Phone/Fax

Practice location:
  • Phone: 616-327-6191
  • Fax: 616-333-4928
Mailing address:
  • Phone: 616-327-6191
  • Fax: 616-333-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: