Healthcare Provider Details

I. General information

NPI: 1689491607
Provider Name (Legal Business Name): MI FLOORTIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17216 VAN WAGONER RD
SPRING LAKE MI
49456-8705
US

IV. Provider business mailing address

533 WOODLAWN AVE
GRAND HAVEN MI
49417-2139
US

V. Phone/Fax

Practice location:
  • Phone: 616-402-6997
  • Fax: 616-499-4968
Mailing address:
  • Phone: 616-402-6997
  • Fax: 616-499-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KAYLIE STEARNS
Title or Position: OWNER
Credential: OTR/L
Phone: 616-402-6997