Healthcare Provider Details

I. General information

NPI: 1891909412
Provider Name (Legal Business Name): BRIAN WILLIAM ARROL OTL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRIAN WILLIAM ARROL OTL

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/19/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11096 WATERSIDE DR
DAVISBURG MI
48350-3561
US

IV. Provider business mailing address

11096 WATERSIDE DR
DAVISBURG MI
48350-3561
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-9203
  • Fax: 248-625-9203
Mailing address:
  • Phone: 248-892-1578
  • Fax: 248-625-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201001520
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: