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General NPI Number Information
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NPI Number | 1205303492
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Entity Type | Individual
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Provider Name | NATALIE SUE OPHOFF
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Gender | Female
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 111 LAKESIDE DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3811
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Country | US
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Telephone | 616-456-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 3985 SANTE FE CT. SW
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City | GRANDVILLE
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State | MI
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Zip | 49418
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Country | US
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Telephone | 616-307-9107
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502005641
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License Number State | MI
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