Basic Information
| Provider Information | |||||||||
| NPI: | 1598056947 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DURST | ||||||||
| FirstName: | JEREMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34650 CEDAR RDG | ||||||||
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| City: | RICHMOND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480625571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104341835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 KEEWAYDIN DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
| FaxNumber: | 8664201055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2011 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201007954 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.