Provider Demographics
NPI:1134997984
Name:SKOKNA, IRENE KATE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:KATE
Last Name:SKOKNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GOLD AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-6321
Mailing Address - Country:US
Mailing Address - Phone:847-431-3462
Mailing Address - Fax:
Practice Address - Street 1:45 GOLD AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-6321
Practice Address - Country:US
Practice Address - Phone:847-431-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist