Provider Demographics
NPI:1669687554
Name:VISITING THERAPISTS ASSOC. OF KALAMAZOO, INC.
Entity Type:Organization
Organization Name:VISITING THERAPISTS ASSOC. OF KALAMAZOO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NOELEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:269-353-6565
Mailing Address - Street 1:5364 GREEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1266
Mailing Address - Country:US
Mailing Address - Phone:269-353-6565
Mailing Address - Fax:
Practice Address - Street 1:2410 CARLYLE DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2216
Practice Address - Country:US
Practice Address - Phone:269-383-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17406A225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP17800Medicare ID - Type UnspecifiedOT
MIOP19700Medicare ID - Type UnspecifiedPHYSICAL THERAPY