Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | MI |
NPI | 1104406651 |
---|---|
Provider Name | Jacqueline Levette Sarvis |
First Address | Grand Rapids, MI 49506-4336 |
Second Address | Grand Rapids, MI 49506-4336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2021 |
Last Update Date | 09/04/2021 |