Provider Demographics
NPI:1932294105
Name:KALAMAZOO AREA REHABILITATION SERVICES PC
Entity Type:Organization
Organization Name:KALAMAZOO AREA REHABILITATION SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERT
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:269-544-3764
Mailing Address - Street 1:6376 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2811
Mailing Address - Country:US
Mailing Address - Phone:269-544-3764
Mailing Address - Fax:269-544-3767
Practice Address - Street 1:6376 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2811
Practice Address - Country:US
Practice Address - Phone:269-544-3764
Practice Address - Fax:269-544-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI670C911590OtherBLUE CROSS SUPPLEMENTAL #
MI64-30122OtherIBA/PHP ID#
MI0N42970Medicare ID - Type UnspecifiedMEDICARE OT GROUP