Healthcare Provider Details

I. General information

NPI: 1508438219
Provider Name (Legal Business Name): ARBOR AUTISM CENTERS ALLIED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HATCHER CRES
ANN ARBOR MI
48103-2426
US

IV. Provider business mailing address

1400 HATCHER CRES
ANN ARBOR MI
48103-2426
US

V. Phone/Fax

Practice location:
  • Phone: 734-657-1470
  • Fax: 734-527-5981
Mailing address:
  • Phone: 734-657-1470
  • Fax: 734-527-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PHILIP MENARD
Title or Position: MEMBER
Credential:
Phone: 734-657-1470