Healthcare Provider Details

I. General information

NPI: 1811102767
Provider Name (Legal Business Name): ERIN JANE KASPRZAK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 S 168TH AVE
HOLLAND MI
49424-2390
US

IV. Provider business mailing address

481 S 168TH AVE
HOLLAND MI
49424-2390
US

V. Phone/Fax

Practice location:
  • Phone: 407-513-3000
  • Fax:
Mailing address:
  • Phone: 407-690-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201007490
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 11914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: