Healthcare Provider Details

I. General information

NPI: 1114279890
Provider Name (Legal Business Name): JENNI BAYLIFF MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42804 GARFIELD RD
CLINTON TOWNSHIP MI
48038-1656
US

IV. Provider business mailing address

42804 GARFIELD RD
CLINTON TOWNSHIP MI
48038-1656
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-2957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number5201008369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: