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Individual

MRS. ANITA JOY EDWARDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
1059 WEALTHY ST SE UNIT 301, GRAND RAPIDS, MI 49506-1690
(616) 777-7631
Mailing address
1059 WEALTHY ST SE UNIT 301, GRAND RAPIDS, MI 49506-1690

Taxonomy

Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
224ZE0001X
Environmental Modification Occupational Therapy Assistant
405300000X
Prevention Professional
5202003641
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1009423
CERTIFIED OCCUPATIONAL THERAPY ASSISTANT
01
1210601573
NATIONAL ACADEMY OF SPORTS MEDICINE
01
5202003641
OCCUPATIONAL THERAPY ASSISTANT LICENSE
MI
Enumeration date
01/12/2022
Last updated
01/12/2022
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