Provider Demographics
NPI:1386985075
Name:PRINE, NATHAN ALLAN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALLAN
Last Name:PRINE
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 MAPLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1032
Mailing Address - Country:US
Mailing Address - Phone:269-544-2901
Mailing Address - Fax:269-341-9919
Practice Address - Street 1:626 MAPLE HILL DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1032
Practice Address - Country:US
Practice Address - Phone:269-544-2901
Practice Address - Fax:269-341-9919
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist