Individual
JENNIFER FORTUNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
625 KENMOOR AVE SE STE 306, GRAND RAPIDS, MI 49546-2395
(616) 942-5744
Mailing address
1859 VALLEY PINES DR, HASTINGS, MI 49058-8261
(616) 724-0338
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201008980
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306876438
—
MI
Enumeration date
03/13/2018
Last updated
03/13/2018
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