Individual
JACLYN MARIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
124 W FOURTH ST, SUTTONS BAY, MI 49682-9733
(231) 271-1200
(231) 271-1214
Mailing address
2830 S PINE MEADOW PATH, SUTTONS BAY, MI 49682-9740
(231) 218-2302
(231) 271-1214
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201005612
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43-2035142
TAX ID
MI
Enumeration date
09/07/2007
Last updated
10/28/2013
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