Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OC003085L | PA |
N | 225XG0600X | Occupational Therapist - Gerontology | OT5850 | OH |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC003085L | PA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT5850 | OH |
NPI | 1073857934 |
---|---|
Provider Name | Mr. Eric John Stockhoff |
First Address | Grand Rapids, MI 49546-7085 |
Second Address | Grand Rapids, MI 49546-7085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |