Healthcare Provider Details

I. General information

NPI: 1265397186
Provider Name (Legal Business Name): MARY FREE BED ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 E BELTLINE AVE NE STE 102
GRAND RAPIDS MI
49525-9324
US

IV. Provider business mailing address

235 WEALTHY ST SE STE 1100
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8007
  • Fax: 616-840-9602
Mailing address:
  • Phone: 616-840-8007
  • Fax: 616-840-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SANDRA G BAKER
Title or Position: REVENUE CYCLE LEAD, CONTRACT COORD.
Credential:
Phone: 616-840-8552