MEDICARE: KATHERINE OVERBEEK OTRL

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
1	225XP0200X	Pediatric Occupational Therapist	5201013823	MI

General Provider Information

NPI Number	:	1578310298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE OVERBEEK OTRL

Provider Business Mailing Address
First Line	:	2681 GLENCAIRIN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2372
Country	:	US
Telephone Number	:	616-469-7686
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 KENMOOR AVE SE STE 110
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2379
Country	:	US
Telephone Number	:	616-591-2905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “ KATHERINE OVERBEEK OTRL” Practice Location

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