Basic Information
Provider Information
NPI: 1689256851
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWNLEE
FirstName: ERIC
MiddleName: MICHAEL
NamePrefix: MR.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9210 E BASSETT CT
Address2:  
City: LIVONIA
State: MI
PostalCode: 481503370
CountryCode: US
TelephoneNumber: 7346744094
FaxNumber:  
Practice Location
Address1: 36475 5 MILE RD
Address2:  
City: LIVONIA
State: MI
PostalCode: 481541971
CountryCode: US
TelephoneNumber: 7346554800
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/26/2021
LastUpdateDate: 04/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X5201010796MIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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