Provider Demographics
NPI:1568958049
Name:MULDERS, JORDAN BRANDI
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BRANDI
Last Name:MULDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-8713
Mailing Address - Country:US
Mailing Address - Phone:989-239-1340
Mailing Address - Fax:
Practice Address - Street 1:11012 E 13 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2547
Practice Address - Country:US
Practice Address - Phone:586-573-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010266225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist