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General NPI Number Information
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NPI Number | 1578280913
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Entity Type | Individual
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Provider Name | SANDRA TRINH PATRICK OTD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 145 S MAIN ST STE 4
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City | WAYLAND
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State | MI
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Zip | 49348-1702
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Country | US
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Telephone | 269-792-2353
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 SAFFRON LN SE APT 3A
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-7351
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Country | US
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Telephone | 616-828-8230
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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 |
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License Number State |
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