Healthcare Provider Details

I. General information

NPI: 1255811501
Provider Name (Legal Business Name): CAROL HOMCO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

IV. Provider business mailing address

45812 BARTLETT DR
CANTON MI
48187-1512
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-6410
  • Fax:
Mailing address:
  • Phone: 734-718-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201002277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: