Provider Demographics
NPI:1407391816
Name:POHL, KATI MARIE (MSOTRL)
Entity Type:Individual
Prefix:MRS
First Name:KATI
Middle Name:MARIE
Last Name:POHL
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:KATI
Other - Middle Name:MARIE
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 CEDAR ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1375
Mailing Address - Country:US
Mailing Address - Phone:616-690-7433
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:49426-1036
Practice Address - Country:US
Practice Address - Phone:248-462-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist