Provider Demographics
NPI:1114517166
Name:RADIANT FAMILY THERAPIES, LLC
Entity Type:Organization
Organization Name:RADIANT FAMILY THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-309-0768
Mailing Address - Street 1:8382 WALLINWOOD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8382 WALLINWOOD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8343
Practice Address - Country:US
Practice Address - Phone:616-309-0768
Practice Address - Fax:616-309-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty