Individual
BRENNAN P CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
4934 LUXEMBURG ST SE, GRAND RAPIDS, MI 49546-8406
(616) 215-0444
Mailing address
PO BOX 1053, ADA, MI 49301-1053
(616) 215-0444
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
85823
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85823
NATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION (NCTRC)
MI
Enumeration date
12/29/2022
Last updated
12/29/2022
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