Basic Information
| Provider Information | |||||||||
| NPI: | 1558664086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOOISTRA | ||||||||
| FirstName: | LYNDSEY | ||||||||
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| Credential: | OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CEDAR SPRINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493198919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168939220 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 S MAIN | ||||||||
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| City: | CEDAR SPRINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493198925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166966555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2010 | ||||||||
| LastUpdateDate: | 12/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201007606 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.