Provider Demographics
NPI:1861386088
Name:WEST MICHIGAN NEURO AND FUNCTIONAL REHABILITATION LLC
Entity type:Organization
Organization Name:WEST MICHIGAN NEURO AND FUNCTIONAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST; OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:616-312-5592
Mailing Address - Street 1:205 W 29TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6973
Mailing Address - Country:US
Mailing Address - Phone:616-312-5592
Mailing Address - Fax:
Practice Address - Street 1:205 W 29TH ST STE 2
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6973
Practice Address - Country:US
Practice Address - Phone:616-312-5592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty