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NPI Code Detail

MEDICARE: CANTON BCC LLC

MEDICARE: CANTON BCC LLC
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
1225XP0200XPediatric Occupational Therapist
2235Z00000XSpeech-Language Pathologist
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1437999257
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANTON BCC LLC
Provider Business Mailing Address
First Line : 44225 W 12 MILE RD STE C-106
Second Line :
City : NOVI
State : MI
Zip : 48377-2640
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 39453 FORD RD
Second Line :
City : CANTON
State : MI
Zip : 48187-4320
Country : US
Telephone Number : 248-277-3005
Fax Number :
Authorized Official
Title or Position : CEO & FOUNDER
Name : ZIAD KOZA
Credential :
Telephone Number : 248-277-3005
Provider Enumeration Date : 05/29/2024
Last Update Date : 05/29/2024

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Directions to “CANTON BCC LLC ” Practice Location

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