Provider Demographics
NPI:1255961066
Name:OOM, BRITTANY (CTRS)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:OOM
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:LITCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:8382 TIMPSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9659
Mailing Address - Country:US
Mailing Address - Phone:616-915-0623
Mailing Address - Fax:
Practice Address - Street 1:475 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5600
Practice Address - Country:US
Practice Address - Phone:616-855-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63173225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist