Healthcare Provider Details

I. General information

NPI: 1568958049
Provider Name (Legal Business Name): JORDAN BRANDI MULDERS OTRL, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
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

3539 21ST ST
WYANDOTTE MI
48192-6303
US

V. Phone/Fax

Practice location:
  • Phone: 734-627-8001
  • Fax: 734-433-1989
Mailing address:
  • Phone: 989-239-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010266
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: