Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1083955256 |
---|---|
Provider Name | Timothy Rahl JR. |
First Address | Grand Rapids, MI 49546-8411 |
Second Address | Grand Rapids, MI 49546-8411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 12/03/2013 |