Healthcare Provider Details

I. General information

NPI: 1750295291
Provider Name (Legal Business Name): LAKESIDE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4726 LAKE RIDGE DR
HOLLAND MI
49423-8955
US

IV. Provider business mailing address

4726 LAKE RIDGE DR
HOLLAND MI
49423-8955
US

V. Phone/Fax

Practice location:
  • Phone: 616-283-2471
  • Fax:
Mailing address:
  • Phone: 616-283-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARA WEBER
Title or Position: WEBER
Credential:
Phone: 616-283-2471