MEDICARE: MRS. EILEEN BARBARA SOMERS B.S, M, A REGISTERED

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	225X00000X	Occupational Therapist	5201002315	MI
2	225XP0200X	Pediatric Occupational Therapist	5201002315	MI

General Provider Information

NPI Number	:	1578621330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN BARBARA SOMERS B.S, M, A REGISTERED

Provider Business Mailing Address
First Line	:	11930 WHITMORE LAKE RD.
Second Line	:	SUITE I-M
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189
Country	:	US
Telephone Number	:	734-449-4649
Fax Number	:	734-449-4669

Provider Business Practice Location Address
First Line	:	11930 WHITMORE LAKE RD.
Second Line	:	SUITE I-M
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189
Country	:	US
Telephone Number	:	734-449-4649
Fax Number	:	734-449-4669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/19/2013

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