Basic Information
| Provider Information | |||||||||
| NPI: | 1932538550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | NYARADZAI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | C.O.T.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WASHINGTON | ||||||||
| OtherFirstName: | DORIS | ||||||||
| OtherMiddleName: | NYARADZAI | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | C.O.T.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3040 WATERCHASE WAY SW APT 312 | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495195955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167197353 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2786 56TH ST SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494188708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162613960 | ||||||||
| FaxNumber: | 6162613925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 520007194 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.