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NPI Code Detail

MEDICARE: MONICA LOR NOVAK OTR

MEDICARE: MONICA LOR NOVAK OTR
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
1225XN1300XNeurorehabilitation Occupational Therapist5201003396MI

General Provider Information

NPI Number : 1619116928
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA LOR NOVAK OTR
Provider Business Mailing Address
First Line : 3590 PONDEROSA DR
Second Line :
City : OKEMOS
State : MI
Zip : 48864-4030
Country : US
Telephone Number : 517-202-7040
Fax Number :
Provider Business Practice Location Address
First Line : 2775 E LANSING DR
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-7755
Country : US
Telephone Number : 517-332-1616
Fax Number : 517-336-4797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2009
Last Update Date : 08/31/2016

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Directions to “ MONICA LOR NOVAK OTR” Practice Location

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