Healthcare Provider Details

I. General information

NPI: 1801034376
Provider Name (Legal Business Name): DEBRA KOEPELE KUPTZ MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42627 GARFIELD RD SUITE 214
CLINTON TOWNSHIP MI
48038-5032
US

IV. Provider business mailing address

37497 CHARTER OAKS BLVD
CLINTON TOWNSHIP MI
48036-2415
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-5345
  • Fax: 586-228-5393
Mailing address:
  • Phone: 734-673-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: