Healthcare Provider Details

I. General information

NPI: 1558885384
Provider Name (Legal Business Name): MR. MATTHEW WAYNE OAKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE DR SE STE 305
GRAND RAPIDS MI
49546-8292
US

IV. Provider business mailing address

4100 LAKE DR SE STE 305
GRAND RAPIDS MI
49546-8292
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number5201005738
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: