Healthcare Provider Details

I. General information

NPI: 1699685958
Provider Name (Legal Business Name): TABER WESTON RESCHKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1057
ADA MI
49301-1057
US

IV. Provider business mailing address

37681 AMRHEIN RD
LIVONIA MI
48150-5014
US

V. Phone/Fax

Practice location:
  • Phone: 616-648-1640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202010415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: