Basic Information
| Provider Information | |||||||||
| NPI: | 1063711091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARA | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | EMILY | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42615 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864122845 | ||||||||
| FaxNumber: | 5864127087 | ||||||||
| Practice Location | |||||||||
| Address1: | 1432 E 12 MILE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480712651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485434886 | ||||||||
| FaxNumber: | 2485430479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2011 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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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 | 225X00000X | 5201007924 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.