MEDICARE: GEM JEWELL

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	225X00000X	Occupational Therapist	5201008469	MI

General Provider Information

NPI Number	:	1710489455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEM JEWELL

Provider Business Mailing Address
First Line	:	5785 ADA DR SE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-7832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 KALAMAZOO AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-3605
Country	:	US
Telephone Number	:	616-827-5986
Fax Number	:

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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Directions to “ GEM JEWELL ” Practice Location

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