| NPI | 1467873414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Mange Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2025-09-23 |