Healthcare Provider Details

I. General information

NPI: 1952077489
Provider Name (Legal Business Name): JEFFREY JOHN SANTINI OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 HENRY STREET
MUSKEGON MI
49441-3564
US

IV. Provider business mailing address

18000 COVE STREET SUITE 202
SPRING LAKE MI
49456-1383
US

V. Phone/Fax

Practice location:
  • Phone: 231-755-4404
  • Fax: 231-755-7704
Mailing address:
  • Phone: 616-847-1280
  • Fax: 616-847-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007638
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number201705116
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: