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General NPI Number Information
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NPI Number | 1598231516
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Entity Type | Individual
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Provider Name | JORDYN ALEXIS ROBERTS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 280 W 40TH ST
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City | HOLLAND
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State | MI
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Zip | 49423-4664
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Country | US
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Telephone | 616-796-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 3273 TOMAHAWK DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1956
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Country | US
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Telephone | 616-901-0904
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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 | 5201010387
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License Number State | MI
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