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General NPI Number Information
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NPI Number | 1578066205
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Entity Type | Individual
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Provider Name | ALYSSA VANDER BENT
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Gender | Female
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-252-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 5715 SCOTSGLEN CT
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City | CALEDONIA
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State | MI
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Zip | 49316-7783
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201008984
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License Number State | MI
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