Healthcare Provider Details

I. General information

NPI: 1619894664
Provider Name (Legal Business Name): GRACE POLLACK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

IV. Provider business mailing address

38755 LYNDON ST
LIVONIA MI
48154-4726
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: