Healthcare Provider Details

I. General information

NPI: 1023052412
Provider Name (Legal Business Name): JOEL M PHILLIPS O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 S 9TH ST
KALAMAZOO MI
49009-9462
US

IV. Provider business mailing address

2297 S 9TH ST
KALAMAZOO MI
49009-9462
US

V. Phone/Fax

Practice location:
  • Phone: 269-377-5594
  • Fax: 888-594-4367
Mailing address:
  • Phone: 269-377-5594
  • Fax: 888-594-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201006390
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number5201006390
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201006390
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: