Mary Vanderwal, COTAL, DOR

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5202004267 Issued in MI

Practice address

2320 E Beltline Ave SE
Grand Rapids, MI 49546-5906

Phone

(616) 831-8643

NPI assigned

Feb 12, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1821554031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9199 WHITNEYVILLE AVE SE",
            "city": "ALTO",
            "state": "MI",
            "postal_code": "493029567",
            "telephone_number": "616-292-5760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465906",
            "telephone_number": "616-831-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWAL",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "COTAL, DOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-12",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "MI",
            "license": "5202004267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Lauren Vandervelde, PA-C
• Marielle Vandervennen, MD
• Judith A Vanderwal, PHD LLP
• Lori Vanderwal
• Lynn Marie Vanderwal, LMSW
• David Arthur Vanderwall, M.D.
• Jennifer Vanderwall, PA-C
• Nathan Vanderwall
• Lori Lynn Vanderweele, RD, CSP
• Clara Vanderweide

• Occupational Therapy Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Occupational Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.