Basic Information
| Provider Information | |||||||||
| NPI: | 1306141510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DETROIT INSTITUTE FOR CHILDREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5447 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482024009 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 5447 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482024009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138321100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2011 | ||||||||
| LastUpdateDate: | 01/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | LUANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3135784511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201007733 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.