Provider Demographics
NPI:1598208779
Name:PORRITT, HALIE (CTRS)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:
Last Name:PORRITT
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90002
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9919
Mailing Address - Country:US
Mailing Address - Phone:616-828-5492
Mailing Address - Fax:855-207-3270
Practice Address - Street 1:8605 HUCKLEBERRY LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8805
Practice Address - Country:US
Practice Address - Phone:616-828-5492
Practice Address - Fax:855-207-3270
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist