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NPI Code Detail

MEDICARE: JUSTINE GONZALEZ BRATT M.S., OTR/L

MEDICARE: JUSTINE GONZALEZ BRATT M.S., OTR/L
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 Therapist5201008645MI

General Provider Information

NPI Number : 1730549577
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE GONZALEZ BRATT M.S., OTR/L
Provider Business Mailing Address
First Line : 933 BEECHWOOD ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-3709
Country : US
Telephone Number : 517-648-2228
Fax Number :
Provider Business Practice Location Address
First Line : 2251 EAST PARIS AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2431
Country : US
Telephone Number : 616-447-7799
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2016
Last Update Date : 03/04/2016

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