Basic Information
| Provider Information | |||||||||
| NPI: | 1922210749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALTZELL | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L, ATRI-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10495 HILL ST. | ||||||||
| Address2: | |||||||||
| City: | PINCKNEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173205050 | ||||||||
| FaxNumber: | 7344623596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349367070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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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 | 225XP0019X | 5201006804 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.