Healthcare Provider Details

I. General information

NPI: 1669039350
Provider Name (Legal Business Name): ALICIA BUHNERKEMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date: 06/21/2025
Reactivation Date: 07/30/2025

III. Provider practice location address

23537 TELEGRAPH RD
BROWNSTOWN TOWNSHIP MI
48134-9330
US

IV. Provider business mailing address

19853 OUTER DR STE 110
DEARBORN MI
48124-2044
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-4601
  • Fax:
Mailing address:
  • Phone: 313-406-5056
  • Fax: 248-712-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: