Healthcare Provider Details

I. General information

NPI: 1255149464
Provider Name (Legal Business Name): REBECCA ANDREA FARRELL OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 JACKSON RD STE D
ANN ARBOR MI
48103-1867
US

IV. Provider business mailing address

4850 HIDDEN BROOK LN
ANN ARBOR MI
48105-9663
US

V. Phone/Fax

Practice location:
  • Phone: 734-627-8001
  • Fax: 734-433-1989
Mailing address:
  • Phone: 317-523-3976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: