Healthcare Provider Details

I. General information

NPI: 1134646094
Provider Name (Legal Business Name): JEANNE MARIE TROMPETER MS, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S MAIN ST STE 4
WAYLAND MI
49348-1702
US

IV. Provider business mailing address

5376 GLEN HARBOR DR
KALAMAZOO MI
49009-9535
US

V. Phone/Fax

Practice location:
  • Phone: 269-792-2353
  • Fax:
Mailing address:
  • Phone: 12698232789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009895
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: