Healthcare Provider Details

I. General information

NPI: 1457596819
Provider Name (Legal Business Name): OP THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S MAIN ST
PLAINWELL MI
49080-1683
US

IV. Provider business mailing address

131 S MAIN ST
PLAINWELL MI
49080-1683
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-5604
  • Fax:
Mailing address:
  • Phone: 269-685-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN COOKE
Title or Position: PRESIDENT
Credential:
Phone: 800-950-3005