Provider Demographics
NPI:1073037313
Name:GREAT LAKES HAND THERAPY PC
Entity Type:Organization
Organization Name:GREAT LAKES HAND THERAPY PC
Other - Org Name:HAND THERAPY OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERDER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:269-979-0874
Mailing Address - Street 1:3600 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9393
Mailing Address - Country:US
Mailing Address - Phone:269-979-0874
Mailing Address - Fax:
Practice Address - Street 1:8175 CREEKSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5370
Practice Address - Country:US
Practice Address - Phone:269-321-3011
Practice Address - Fax:269-321-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty