Provider Demographics
NPI:1124597547
Name:MPOFU, FIKILE WENDY
Entity Type:Individual
Prefix:
First Name:FIKILE
Middle Name:WENDY
Last Name:MPOFU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FIKILE
Other - Middle Name:WENDY
Other - Last Name:MKHIZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3453 EASY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3744
Mailing Address - Country:US
Mailing Address - Phone:269-944-7119
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9225
Practice Address - Country:US
Practice Address - Phone:269-463-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002981225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist