Healthcare Provider Details

I. General information

NPI: 1093442741
Provider Name (Legal Business Name): KHADRA LOUISE SKOWRONEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E OAKLEY PARK RD STE 101B
COMMERCE TOWNSHIP MI
48390-1500
US

IV. Provider business mailing address

PO BOX 412031
BOSTON MA
02241-2031
US

V. Phone/Fax

Practice location:
  • Phone: 732-965-8475
  • Fax: 732-719-7156
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: