Basic Information
| Provider Information | |||||||||
| NPI: | 1801122890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRAWL, WALK, JUMP, RUN THERAPY CLINIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43239 SCHOENHERR RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483131957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863232957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43239 SCHOENHERR RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483131957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863232957 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2009 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | MULRENIN | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPY | ||||||||
| AuthorizedOfficialTelephone: | 5863232957 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | 5201007297 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.