Individual
COREY R VANDERWULP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1650 BARLOW ST, TRAVERSE CITY, MI 49686-4721
(231) 941-3100
(231) 922-0382
Mailing address
1650 BARLOW ST, TRAVERSE CITY, MI 49686-4721
(231) 941-3100
(231) 922-0382
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201004911
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43-2035142
GLTHC TAX ID
MI
Enumeration date
11/28/2012
Last updated
11/28/2012
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