Individual
JEANNE MONIQUE VANDER WAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
2100 E PROVINCIAL HOUSE DR, LANSING, MI 48910-4884
(517) 272-4029
Mailing address
1014 FREDERICK AVE NW, GRAND RAPIDS, MI 49504-4042
(616) 309-3551
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007161
MI
Other
Enumeration date
11/24/2011
Last updated
11/24/2011
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