Provider Demographics
NPI:1578280913
Name:PATRICK, SANDRA TRINH (OTD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:TRINH
Last Name:PATRICK
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 SAFFRON LN SE APT 3A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7351
Mailing Address - Country:US
Mailing Address - Phone:616-828-8230
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1702
Practice Address - Country:US
Practice Address - Phone:269-792-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist