Basic Information
| Provider Information | |||||||||
| NPI: | 1093155830 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ORTIZ | ||||||||
| FirstName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12055 TOWNLINE RD | ||||||||
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| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484391660 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 HIGHLAND AVE | ||||||||
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| City: | MILFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483811517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486851460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5202007497 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.