Basic Information
| Provider Information | |||||||||
| NPI: | 1225465396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFE SKILLS REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3604 CLARKSTON RD | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483485215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488149300 | ||||||||
| FaxNumber: | 2488140361 | ||||||||
| Practice Location | |||||||||
| Address1: | 3604 CLARKSTON RD | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483485215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488149300 | ||||||||
| FaxNumber: | 2488140361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | DALTON | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2488149300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTRL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201004452 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.