Provider Demographics
NPI:1972264620
Name:KOETJE, DAVID J (BT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:KOETJE
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8136
Mailing Address - Country:US
Mailing Address - Phone:616-251-8162
Mailing Address - Fax:616-327-4660
Practice Address - Street 1:421 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8136
Practice Address - Country:US
Practice Address - Phone:616-251-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician