Provider Demographics
NPI:1639287220
Name:VENNIX, CYNTHIA L (OT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:VENNIX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8242
Mailing Address - Country:US
Mailing Address - Phone:269-657-1490
Mailing Address - Fax:269-365-7144
Practice Address - Street 1:9863 SUNNYWOOD DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7967
Practice Address - Country:US
Practice Address - Phone:269-372-1669
Practice Address - Fax:269-657-1444
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001963225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201001963OtherSTATE REGISTRATION