Healthcare Provider Details

I. General information

NPI: 1578732228
Provider Name (Legal Business Name): TRICIA MARIE WHEELOCK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BURTON ST SE
GRAND RAPIDS MI
49506-4670
US

IV. Provider business mailing address

1940 44TH ST SE
KENTWOOD MI
49508-5008
US

V. Phone/Fax

Practice location:
  • Phone: 616-241-5534
  • Fax: 616-241-4868
Mailing address:
  • Phone: 616-530-1977
  • Fax: 616-530-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number5201006646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: