Individual
MRS. ELISE RENEE DIRKSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
7086 8TH AVE, JENISON, MI 49428-9352
(616) 667-9551
(616) 667-9552
Mailing address
1074 28TH AVE, HUDSONVILLE, MI 49426-9630
(616) 896-6484
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201000987
MI
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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