| NPI | 1790558633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA BANTA Office Administrator 269-845-5970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2024-09-09 |