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NPI Code Detail

MEDICARE: SHOLLY RAHMAN

MEDICARE: SHOLLY RAHMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist52001007212MI

General Provider Information

NPI Number : 1093217697
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOLLY RAHMAN
Provider Business Mailing Address
First Line : 32410 QUEENSBORO ST
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-1634
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16001 W 9 MILE RD
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-849-3465
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 02/28/2018

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