Jesse B. Nicodemus MOT
Occupational Therapist in Grand Rapids, MI(View on Map)
Full Name
Jesse Bryan Nicodemus MOT
NPI Number
1386114734
NPI Type
Individual Provider
Gender
Male
Enumeration Date
11/28/2018
Specialties
(Taxonomies)Licenses
State
Michigan
License Number
201009340
Contact
Information
Purpose
Mailing
Location
Address
2320 E BELTLINE AVE SE
2320 E BELTLINE AVE SE
City
Grand Rapids
Grand Rapids
State
MI
MI
Postal Code
49546-5906
49546-5906
Country
US
US
Telephone Number
(616) 831-8666
(616) 831-8666
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 11/28/2018