Provider Demographics
NPI:1265005151
Name:HOME CONNECTION THERAPY LLC
Entity Type:Organization
Organization Name:HOME CONNECTION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERLAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L, CCM
Authorized Official - Phone:616-890-8660
Mailing Address - Street 1:1232 GRISWOLD ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3815
Mailing Address - Country:US
Mailing Address - Phone:616-890-8660
Mailing Address - Fax:
Practice Address - Street 1:1232 GRISWOLD ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3815
Practice Address - Country:US
Practice Address - Phone:616-890-8660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty