Healthcare Provider Details

I. General information

NPI: 1790609352
Provider Name (Legal Business Name): JEREMY GIORDANA CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4661
US

IV. Provider business mailing address

200 W SPRING ST
MARQUETTE MI
49855-4661
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-9835
  • Fax: 906-225-7282
Mailing address:
  • Phone: 906-225-9835
  • Fax: 906-225-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number51634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: