Provider Demographics
NPI:1952512576
Name:BYLSMA, REBECCA MAE (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MAE
Last Name:BYLSMA
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:MAE
Other - Last Name:MULDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR
Mailing Address - Street 1:1400 BECKWITH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5812
Mailing Address - Country:US
Mailing Address - Phone:616-458-1962
Mailing Address - Fax:616-452-7894
Practice Address - Street 1:630 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-975-6200
Practice Address - Fax:616-975-5400
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000134225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952512576Medicaid