Healthcare Provider Details

I. General information

NPI: 1447756044
Provider Name (Legal Business Name): CALEB ANDREW WOOD OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HANCOCK ST
SAGINAW MI
48602-4224
US

IV. Provider business mailing address

3285 SCHUST RD APT 106
SAGINAW MI
48603-8111
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-3400
  • Fax:
Mailing address:
  • Phone: 989-252-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: