Basic Information
| Provider Information | |||||||||
| NPI: | 1720528581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORSHAM | ||||||||
| FirstName: | MALAIKA | ||||||||
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| Credential: | B.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3231 S GULLEY RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132782327 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3231 S GULLEY RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132782327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | ME | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 225X00000X | 5201011100 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.