Basic Information
| Provider Information | |||||||||
| NPI: | 1891366506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OOSTERHOUSE | ||||||||
| FirstName: | KENLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6152 W FIELDSTONE HILLS DR SE APT 8 | ||||||||
| Address2: | |||||||||
| City: | CALEDONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493167643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694252562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 N CENTER ST | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493311212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168978473 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2021 | ||||||||
| LastUpdateDate: | 07/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.