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General NPI Number Information
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NPI Number | 1124457866
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Entity Type | Individual
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Provider Name | MRS. JENNIFER LYNN SANDBORN
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 7855 CURRIER DR
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City | PORTAGE
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State | MI
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Zip | 49002-4314
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Country | US
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Telephone | 269-323-7748
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Fax | 269-323-1908
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Provider Business Mailing Address
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Address Line | 8830 COTTONWOOD CRK
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City | PORTLAND
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State | MI
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Zip | 48875-9371
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Country | US
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Telephone | 517-449-5315
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Fax | 414-815-5387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5201005410
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License Number State | MI
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