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General NPI Number Information
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NPI Number | 1508770371
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Entity Type | Individual
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Provider Name | SAMUEL R STORIE
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Gender | Male
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 14055 S MASON DR
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City | GRANT
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State | MI
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Zip | 49327-9645
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Country | US
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Telephone | 231-834-8433
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Fax |
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Provider Business Mailing Address
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Address Line | 1159 JOOSTEN ST SW APT 2
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City | WYOMING
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State | MI
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Zip | 49509-1424
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Country | US
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Telephone | 231-282-1739
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | MI
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