Healthcare Provider Details

I. General information

NPI: 1215961578
Provider Name (Legal Business Name): CHRISTOPHER ELLIOTT MCCARTHY MOT,OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

15992 ROSE DR
ALLEN PARK MI
48101-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax: 313-576-1246
Mailing address:
  • Phone: 313-386-1561
  • Fax: 313-388-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: