Healthcare Provider Details

I. General information

NPI: 1518873843
Provider Name (Legal Business Name): MINDA ROSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4859 KNUDSEN ST
MONTAGUE MI
49437-1342
US

IV. Provider business mailing address

1500 S GETTY ST
MUSKEGON MI
49442-5103
US

V. Phone/Fax

Practice location:
  • Phone: 231-894-9018
  • Fax:
Mailing address:
  • Phone: 231-557-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201008928
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: