Healthcare Provider Details

I. General information

NPI: 1295485886
Provider Name (Legal Business Name): SAVANNAH FAY HENGESBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANNAH BOAK

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 HARWOOD RD
IONIA MI
48846-9458
US

IV. Provider business mailing address

11446 W 2ND ST
FOWLER MI
48835-9116
US

V. Phone/Fax

Practice location:
  • Phone: 616-401-6495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: