MEDICARE: INTEGRATED COGNITIVE REHABILITATION

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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1134410335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED COGNITIVE REHABILITATION

Provider Business Mailing Address
First Line	:	627 E 11 MILE RD
Second Line	:	SUIT 110
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1961
Country	:	US
Telephone Number	:	248-721-9938
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 E 11 MILE RD
Second Line	:	SUIT 110
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1961
Country	:	US
Telephone Number	:	248-721-9938
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FATIMA KADI
Credential	:
Telephone Number	:	248-721-9938

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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