Healthcare Provider Details

I. General information

NPI: 1588593982
Provider Name (Legal Business Name): FULL SAIL THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E 8TH ST STE 32
HOLLAND MI
49423-3765
US

IV. Provider business mailing address

513 E 8TH ST STE 32
HOLLAND MI
49423-3765
US

V. Phone/Fax

Practice location:
  • Phone: 616-510-9637
  • Fax: 616-828-5047
Mailing address:
  • Phone: 616-510-9637
  • Fax: 616-828-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KAYLA ROTMAN
Title or Position: OWNER/MANAGER
Credential: LMSW
Phone: 616-510-9637