Provider Demographics
NPI:1033640248
Name:MOTTES, VINCE
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:MOTTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 CEDAR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9634
Mailing Address - Country:US
Mailing Address - Phone:517-315-1150
Mailing Address - Fax:
Practice Address - Street 1:9550 CEDAR KNOLL DR
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-9634
Practice Address - Country:US
Practice Address - Phone:517-315-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010015102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer