Provider Demographics
NPI:1770025355
Name:STARK, NATALIE MARTINE (OTRL)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARTINE
Last Name:STARK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CITY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1130
Mailing Address - Country:US
Mailing Address - Phone:906-387-2273
Mailing Address - Fax:
Practice Address - Street 1:300 CITY PARK DR
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1130
Practice Address - Country:US
Practice Address - Phone:906-387-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist