Provider Demographics
NPI:1457319865
Name:VANDERMEER, ROBERT (OTR)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VANDERMEER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 W SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4047
Mailing Address - Country:US
Mailing Address - Phone:231-755-6951
Mailing Address - Fax:231-755-4507
Practice Address - Street 1:875 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4047
Practice Address - Country:US
Practice Address - Phone:231-755-6951
Practice Address - Fax:231-755-4507
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist