Healthcare Provider Details

I. General information

NPI: 1336925288
Provider Name (Legal Business Name): RAEANNA HOPE PORRETT MS, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 MOVIE DR
BRIGHTON MI
48116-7444
US

IV. Provider business mailing address

8175 MOVIE DR
BRIGHTON MI
48116-7444
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax:
Mailing address:
  • Phone: 248-277-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013942
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: