Individual
AMANDA POVLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
43815 40TH ST, PAW PAW, MI 49079-9673
(269) 903-6584
Mailing address
43815 40TH ST, PAW PAW, MI 49079-9673
(269) 903-6584
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
10/12/2018
Last updated
04/04/2024
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