Basic Information
| Provider Information | |||||||||
| NPI: | 1023408325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATIMI | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | #1703 515 RIVERSIDE DR W | ||||||||
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| City: | WINDSOR | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | N9A7C3 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 5199803645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11569 E 12 MILE RD | ||||||||
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| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480932645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865820018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5502004433 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.