Individual
LAUREN JANNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1450 LEONARD ST NE, GRAND RAPIDS, MI 49505-5515
(616) 774-8789
Mailing address
1450 LEONARD ST NE, GRAND RAPIDS, MI 49505-5515
(248) 224-8871
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056.012097
IL
225X00000X
Occupational Therapist
Primary
5201010451
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056.012097
STATE LICENSE
IL
01
—
390494
NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY CERTIFICATION
—
01
—
5201010451
STATE LICENSE
MI
Enumeration date
06/12/2018
Last updated
07/11/2019
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