Individual
KYLE L PURDUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
7971 MOORSBRIDGE RD, PORTAGE, MI 49024-4075
(269) 321-0929
(269) 321-1767
Mailing address
7971 MOORSBRIDGE RD, PORTAGE, MI 49024-4075
(269) 321-0929
(269) 321-1767
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201009844
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5201009844
LICENSE #
MI
Enumeration date
04/19/2017
Last updated
04/19/2017
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