Basic Information
| Provider Information | |||||||||
| NPI: | 1144608456 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AA THERAPY WORKS | ||||||||
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| OtherOrganizationName: | A2 THERAPY WORKS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 W LIBERTY RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481039746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347807852 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 W LIBERTY RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481039746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347807852 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2015 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | BUCOVETSKY | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH PATH,EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7347807852 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225XP0200X | 5201004581 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 235Z00000X | 7101004677 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.