Individual
AUDRA LOU KUPERUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
3600 FULTON ST E, GRAND RAPIDS, MI 49546-1322
(616) 949-4971
Mailing address
6351 N BROADWAY RD, FREEPORT, MI 49325-9712
(616) 212-9216
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008414
MI
Other
Enumeration date
10/12/2018
Last updated
02/13/2020
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