MEDICARE: KEVA MARIE WOOD 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	225X00000X	Occupational Therapist	5201011127	MI

General Provider Information

NPI Number	:	1922759273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVA MARIE WOOD OTRL

Provider Business Mailing Address
First Line	:	2021 SECRETARIAT LN
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-8034
Country	:	US
Telephone Number	:	989-640-5309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S SCOTT RD
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-8044
Country	:	US
Telephone Number	:	989-224-8936
Fax Number	:

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

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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