Healthcare Provider Details

I. General information

NPI: 1861231615
Provider Name (Legal Business Name): CODY KALKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 PEREGRINE DR NE
GRAND RAPIDS MI
49525-9723
US

IV. Provider business mailing address

8379 HARVEST AVE
RICHLAND MI
49083-9714
US

V. Phone/Fax

Practice location:
  • Phone: 616-643-0833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: