Healthcare Provider Details

I. General information

NPI: 1578280913
Provider Name (Legal Business Name): SANDRA TRINH PATRICK OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
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

1230 SAFFRON LN SE APT 3A
GRAND RAPIDS MI
49508-7351
US

V. Phone/Fax

Practice location:
  • Phone: 269-792-2353
  • Fax:
Mailing address:
  • Phone: 616-828-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: