Provider Demographics
NPI:1912240482
Name:KORTMAN, JANNA (CTRS)
Entity Type:Individual
Prefix:MISS
First Name:JANNA
Middle Name:
Last Name:KORTMAN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90002
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9919
Mailing Address - Country:US
Mailing Address - Phone:810-434-3339
Mailing Address - Fax:855-207-3270
Practice Address - Street 1:4934 LUXEMBURG ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8406
Practice Address - Country:US
Practice Address - Phone:810-434-3339
Practice Address - Fax:855-207-3270
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist