Individual
MRS. TARA YESKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A.T.C.
Contact information
Practice address
4100 LAKE DR SE, SUITE 300, GRAND RAPIDS, MI 49546-8292
(616) 267-8860
Mailing address
4545 PIMLICO PL, OKEMOS, MI 48864-2392
(860) 573-5532
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
2601001079
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601001079
ATHLETIC TRAINING LICENSE
MI
Enumeration date
11/25/2013
Last updated
11/25/2013
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