Healthcare Provider Details

I. General information

NPI: 1932891132
Provider Name (Legal Business Name): ASHLEY PAIGE VANELLS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MICHIGAN AVE STE 320
JACKSON MI
49201-1854
US

IV. Provider business mailing address

1430 N FOREST HILL RD
SAINT JOHNS MI
48879-9515
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7633
  • Fax: 517-205-7634
Mailing address:
  • Phone: 989-307-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201013331
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201013331
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: