Healthcare Provider Details

I. General information

NPI: 1417878125
Provider Name (Legal Business Name): ASHLEY NICOLE OCONNOR RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

16431 TAMARACK RD
HOWARD CITY MI
49329-9390
US

V. Phone/Fax

Practice location:
  • Phone: 866-989-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4401007028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: