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General NPI Number Information
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NPI Number | 1093585374
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF CONTEXTUAL HUMAN HEALTH, WELLNESS, AND PERFORMANCE
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 5429 NORTHLAND DR NE STE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1089
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Country | US
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Telephone | 616-855-0540
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Fax | 616-855-1185
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Provider Business Mailing Address
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Address Line | 5429 NORTHLAND DR NE STE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1089
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Country | US
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Telephone | 616-855-0540
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | CAMERON FALLER
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Credential |
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Telephone | 989-928-4626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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