Healthcare Provider Details

I. General information

NPI: 1700333614
Provider Name (Legal Business Name): ALETTA JEAN HUISMAN MSOT, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
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:
Mailing address:
  • Phone: 616-327-6191
  • Fax: 616-333-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009609
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201009609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: