Healthcare Provider Details

I. General information

NPI: 1356765580
Provider Name (Legal Business Name): KATHERINE MESKO OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 FULLER AVE NE STE 105
GRAND RAPIDS MI
49505-3459
US

IV. Provider business mailing address

2922 FULLER AVE NE STE 105
GRAND RAPIDS MI
49505-3459
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 Number5201008715
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: