Healthcare Provider Details

I. General information

NPI: 1972086379
Provider Name (Legal Business Name): ZOEY MARIE DEKKER MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZOEY MARIE ROSE OT

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE STE 3003
GRAND RAPIDS MI
49503-2528
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2009
  • Fax:
Mailing address:
  • Phone: 616-486-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201010320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: