Provider Demographics
NPI:1346677325
Name:FUNK, JORDYN (OTRL)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 VICTOR PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7029
Mailing Address - Country:US
Mailing Address - Phone:855-877-1944
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:20000 VICTOR PKWY
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7029
Practice Address - Country:US
Practice Address - Phone:855-877-1944
Practice Address - Fax:734-953-1743
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008598225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation