Healthcare Provider Details

I. General information

NPI: 1710771688
Provider Name (Legal Business Name): WARDA SALEH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 W ALEXANDRINE ST
DETROIT MI
48201-2015
US

IV. Provider business mailing address

5675 LAWNDALE ST
DETROIT MI
48210-1836
US

V. Phone/Fax

Practice location:
  • Phone: 313-631-3360
  • Fax:
Mailing address:
  • Phone: 313-858-7700
  • 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: