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NPI Code Detail

MEDICARE: GREAT LAKES HAND THERAPY PC

MEDICARE: GREAT LAKES HAND THERAPY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1437378932
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES HAND THERAPY PC
Provider Business Mailing Address
First Line : 7901 S 12TH ST
Second Line : SUITE #200
City : PORTAGE
State : MI
Zip : 49024-3831
Country : US
Telephone Number : 269-372-7200
Fax Number : 269-372-1630
Provider Business Practice Location Address
First Line : 7971 MOORSBRIDGE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4075
Country : US
Telephone Number : 269-321-0929
Fax Number : 269-321-1767
Authorized Official
Title or Position : MANAGER
Name : LISA MARIE WILLEMS
Credential :
Telephone Number : 269-372-7200
Provider Enumeration Date : 04/24/2007
Last Update Date : 10/24/2023

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Directions to “GREAT LAKES HAND THERAPY PC ” Practice Location

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