Provider Demographics
NPI:1962824888
Name:RADIANT LIFE THERAPIES LLC
Entity Type:Organization
Organization Name:RADIANT LIFE THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OCCUPATIONAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KATERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:616-677-5117
Mailing Address - Street 1:12455 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:MARNE
Mailing Address - State:MI
Mailing Address - Zip Code:49435-9685
Mailing Address - Country:US
Mailing Address - Phone:616-677-5117
Mailing Address - Fax:
Practice Address - Street 1:12455 LINDEN DR
Practice Address - Street 2:
Practice Address - City:MARNE
Practice Address - State:MI
Practice Address - Zip Code:49435-9685
Practice Address - Country:US
Practice Address - Phone:616-677-5117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE2836L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty