Healthcare Provider Details

I. General information

NPI: 1679857908
Provider Name (Legal Business Name): LAUREN HUNT OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
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 Number5201007232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: