Provider Demographics
NPI:1285197509
Name:WHITMAN, RYAN MARSHALL (OTR/L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARSHALL
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1097
Mailing Address - Country:US
Mailing Address - Phone:616-669-1520
Mailing Address - Fax:
Practice Address - Street 1:3650 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1097
Practice Address - Country:US
Practice Address - Phone:616-669-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist