Individual
MRS. WENDY ROCHELLE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
Mailing address
3955 7 MILE RD NE, BELMONT, MI 49306-9654
(616) 784-5211
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202003651
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285019802
—
MI
05
—
1568554566
—
MI
Enumeration date
03/23/2018
Last updated
03/23/2018
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