Provider Demographics
NPI:1093260234
Name:OPENING DOORS OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:OPENING DOORS OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANICKI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:231-690-4220
Mailing Address - Street 1:3925 HOPKINS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-9351
Mailing Address - Country:US
Mailing Address - Phone:231-690-4220
Mailing Address - Fax:231-316-6040
Practice Address - Street 1:3925 HOPKINS LAKE DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-9351
Practice Address - Country:US
Practice Address - Phone:231-690-4220
Practice Address - Fax:231-316-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008151251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare