Individual
DAVID JOEL VANDYKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 CEDAR ST NE, GRAND RAPIDS, MI 49503-1375
(616) 486-3900
Mailing address
1401 CEDAR ST NE, GRAND RAPIDS, MI 49503-1375
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007537
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5201007537
—
MI
Enumeration date
03/08/2018
Last updated
03/08/2018
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