Healthcare Provider Details

I. General information

NPI: 1144427410
Provider Name (Legal Business Name): HEATHER MICHELE BRAINARD O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E 16TH ST
HOLLAND MI
49423-9127
US

IV. Provider business mailing address

5932 WILDERNESS TRL
HAMILTON MI
49419-9699
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-7095
  • Fax:
Mailing address:
  • Phone: 740-816-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010655
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT- 6480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: