Individual
JAIME RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
117 COURTLAND ST, ROCKFORD, MI 49341-1031
(616) 951-1077
Mailing address
5663 VISTA DE ORO CT NE, ROCKFORD, MI 49341-9406
(616) 438-3133
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201011414
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5201011414
PROFESSIONAL LICENSE NUMBER
MI
Enumeration date
06/16/2022
Last updated
06/16/2022
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