Healthcare Provider Details

I. General information

NPI: 1255167698
Provider Name (Legal Business Name): TAYLOR MARIE SASSACK OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9606
US

IV. Provider business mailing address

8986 POLK ST
ZEELAND MI
49464-8452
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7199
  • Fax:
Mailing address:
  • Phone: 616-283-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: