Healthcare Provider Details

I. General information

NPI: 1336649169
Provider Name (Legal Business Name): LEANNE MA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
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

101 PONDS VIEW DR
ANN ARBOR MI
48103-6606
US

V. Phone/Fax

Practice location:
  • Phone: 734-627-8001
  • Fax:
Mailing address:
  • Phone: 248-705-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: