Healthcare Provider Details

I. General information

NPI: 1164332318
Provider Name (Legal Business Name): ELIZABETH WIDMER M.S. OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 S WAGNER RD
ANN ARBOR MI
48103-9715
US

IV. Provider business mailing address

44567 ANNE CT
PLYMOUTH MI
48170-3931
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-8100
  • Fax:
Mailing address:
  • Phone: 734-968-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: