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General NPI Number Information
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NPI Number | 1669651097
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Entity Type | Organization
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Legal Business Name | OCCUPATIONAL REHABILITATIVE SERVICES LLC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 335 N 120TH AVE 2ND FLOOR
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City | HOLLAND
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State | MI
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Zip | 49424-2118
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Country | US
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Telephone | 616-355-2930
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Fax | 616-392-9030
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Provider Business Mailing Address
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Address Line | 335 N 120TH AVE 2ND FLOOR
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City | HOLLAND
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State | MI
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Zip | 49424-2118
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Country | US
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Telephone | 616-355-2930
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Fax | 616-392-9030
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS FOWLER
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Credential | DC
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Telephone | 616-355-2930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5501009059
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License Number State | MI
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