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General NPI Number Information
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NPI Number | 1902154388
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Entity Type | Organization
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Legal Business Name | KALAMAZOO FUNCTIONAL REHABILIATION- THERAPY TEAM LLC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 6376 QUAIL RUN DR
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City | KALAMAZOO
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State | MI
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Zip | 49009-2811
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Country | US
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Telephone | 269-544-3764
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Fax |
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Provider Business Mailing Address
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Address Line | 3237 OLD COLONY RD
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City | KALAMAZOO
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State | MI
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Zip | 49008-4915
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Country | US
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Telephone | 269-870-6459
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Fax | 269-978-8916
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | JULIE BOL
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Credential |
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Telephone | 269-870-6459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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