MEDICARE: PETER RABBIT DAY CARE CENTER INC

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	235Z00000X	Speech-Language Pathologist
2	225XP0200X	Pediatric Occupational Therapist
3	2251P0200X	Pediatric Physical Therapist
4	171M00000X	Case Manager/Care Coordinator	8200017384	MI

General Provider Information

NPI Number	:	1801154943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER RABBIT DAY CARE CENTER INC

Provider Business Mailing Address
First Line	:	5901 CADIEUX RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2003
Country	:	US
Telephone Number	:	313-882-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 CADIEUX RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2003
Country	:	US
Telephone Number	:	313-882-7446
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BERNITA HAVARD
Credential	:
Telephone Number	:	313-882-7446

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	05/25/2012

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