Provider Demographics
NPI:1598976672
Name:HOCK, NANCY SUE (OTR,L, CHT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:HOCK
Suffix:
Gender:F
Credentials:OTR,L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E. BELTLINE AVE SE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506
Mailing Address - Country:UM
Mailing Address - Phone:616-288-3732
Mailing Address - Fax:616-288-9857
Practice Address - Street 1:1310 E BELTLINE AVE SE
Practice Address - Street 2:SUITE 230
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4300
Practice Address - Country:US
Practice Address - Phone:616-288-3732
Practice Address - Fax:616-288-9857
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 5120225X00000X
MIL898717225X00000X
1011100356225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2679020Medicaid
MI30435OtherBLUE CROSS BLUE SHIELD
MI30435OtherBLUE CROSS BLUE SHIELD