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General NPI Number Information
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NPI Number | 1205223088
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Entity Type | Individual
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Provider Name | JANE BOOMSMA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 2786 56TH ST SW
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City | WYOMING
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State | MI
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Zip | 49418-8708
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Country | US
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Telephone | 616-261-3960
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Fax |
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Provider Business Mailing Address
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Address Line | 7770 WILSON AVE SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8650
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Country | US
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Telephone | 616-690-1241
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5202000514
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License Number State | MI
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