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General NPI Number Information
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NPI Number | 1962824888
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Entity Type | Organization
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Legal Business Name | RADIANT LIFE THERAPIES LLC
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Dates
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Enumeration Date | 01/11/2014
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Last Update Date | 01/11/2014
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Provider Practice Location Address
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Address Line | 12455 LINDEN DR
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City | MARNE
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State | MI
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Zip | 49435-9685
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Country | US
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Telephone | 616-677-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 12455 LINDEN DR
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City | MARNE
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State | MI
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Zip | 49435-9685
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Country | US
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Telephone | 616-677-5117
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OCCUPATIONAL THERAPY
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Name | DR. BARBRA ANN KATERBERG
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Credential | OTD, OTR/L
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Telephone | 616-677-5117
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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 | E2836L
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License Number State | MI
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