Provider Demographics
NPI:1023052412
Name:PHILLIPS, JOEL M (OT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9462
Mailing Address - Country:US
Mailing Address - Phone:269-377-5594
Mailing Address - Fax:888-594-4367
Practice Address - Street 1:2297 S 9TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9462
Practice Address - Country:US
Practice Address - Phone:269-377-5594
Practice Address - Fax:888-594-4367
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006390225X00000X, 225XH1200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023052412OtherNPI
155812OtherGREAT LAKES HLTH PLN
MIOP15760OtherMEDICARE PTAN
MIOP15760OtherMEDICARE PTAN
383148262OtherEIN-HEALTHCARE MIDWEST
MIOP15760OtherMEDICARE PTAN