Basic Information
| Provider Information | |||||||||
| NPI: | 1447733613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARR | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10770 ELIZABETH LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WHITE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483862136 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10770 ELIZABETH LAKE | ||||||||
| Address2: | |||||||||
| City: | WHITE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486184100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2018 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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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 | 225X00000X | 5201007521 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.