Provider Demographics
NPI:1215200514
Name:IRWIN, RYAN KENNETH (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:KENNETH
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6081 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9502
Mailing Address - Country:US
Mailing Address - Phone:989-274-8165
Mailing Address - Fax:
Practice Address - Street 1:6081 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9502
Practice Address - Country:US
Practice Address - Phone:989-274-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist