Healthcare Provider Details

I. General information

NPI: 1528718343
Provider Name (Legal Business Name): VALERIE JEAN ELKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOODWILL INDUSTRIES OF GREATER DETROIT 3111 GRAND RIVER
DETROIT MI
48208-4820
US

IV. Provider business mailing address

18062 COLGATE ST
DEARBORN HEIGHTS MI
48125-3352
US

V. Phone/Fax

Practice location:
  • Phone: 313-931-0901
  • Fax:
Mailing address:
  • Phone: 313-605-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202004253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: