Provider Demographics
NPI:1922759273
Name:WOOD, KEVA MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:KEVA
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KEVA
Other - Middle Name:MARIE
Other - Last Name:FELDPAUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 SECRETARIAT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8034
Mailing Address - Country:US
Mailing Address - Phone:989-640-5309
Mailing Address - Fax:
Practice Address - Street 1:1101 S SCOTT RD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-8044
Practice Address - Country:US
Practice Address - Phone:989-224-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist