Individual
JONATHAN NICHOLAS CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3300 36TH ST SE, GRAND RAPIDS, MI 49512-2810
(616) 942-2110
Mailing address
3300 36TH ST SE, GRAND RAPIDS, MI 49512-2810
(616) 942-2110
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008279
MI
Other
Enumeration date
01/15/2018
Last updated
01/15/2018
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