Healthcare Provider Details

I. General information

NPI: 1992016513
Provider Name (Legal Business Name): KAREN MARIE MAGUIRE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BAGLEY ST
DETROIT MI
48226-1400
US

IV. Provider business mailing address

220 BAGLEY ST
DETROIT MI
48226-1400
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-7990
  • Fax:
Mailing address:
  • Phone: 313-961-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201002980
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number5201002980
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number5201002980
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201002980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: