Healthcare Provider Details

I. General information

NPI: 1508915505
Provider Name (Legal Business Name): STARR REBECCA CARUTHERS C.T.R.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STARR REBECCA FRITZ C.T.R.S.

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 GRATIOT AVE
DETROIT MI
48205-1973
US

IV. Provider business mailing address

22022 SHARKEY ST
CLINTON TWP MI
48035-3664
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-0600
  • Fax:
Mailing address:
  • Phone: 586-648-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number53614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: