Healthcare Provider Details

I. General information

NPI: 1235842584
Provider Name (Legal Business Name): ALMEDINA OKANOVIC COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40770 MAGNOLIA DR E
CLINTON TOWNSHIP MI
48038-2592
US

IV. Provider business mailing address

40770 MAGNOLIA DR E
CLINTON TOWNSHIP MI
48038-2592
US

V. Phone/Fax

Practice location:
  • Phone: 586-625-3785
  • Fax:
Mailing address:
  • Phone: 586-625-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202010006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: