Basic Information
| Provider Information | |||||||||
| NPI: | 1811472491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDER WERP | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30903 W 10 MILE RD | ||||||||
| Address2: | STE B | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483362615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488936192 | ||||||||
| FaxNumber: | 2484575490 | ||||||||
| Practice Location | |||||||||
| Address1: | 28000 WOODWARD AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480670961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483953777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 5201008703 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.