Healthcare Provider Details

I. General information

NPI: 1700232782
Provider Name (Legal Business Name): COLLEEN GRIFFIN MCFAWN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E BELTLINE AVE SE STE 230
GRAND RAPIDS MI
49506-4304
US

IV. Provider business mailing address

7086 8TH AVENUE
JENISON MI
49428
US

V. Phone/Fax

Practice location:
  • Phone: 616-288-3732
  • Fax: 616-288-9857
Mailing address:
  • Phone: 616-667-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201009477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: