Healthcare Provider Details

I. General information

NPI: 1245897958
Provider Name (Legal Business Name): BOGDANA DARCOHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 E GRAND BLVD
DETROIT MI
48207-3637
US

IV. Provider business mailing address

12524 MORAN ST
DETROIT MI
48212-2329
US

V. Phone/Fax

Practice location:
  • Phone: 313-850-7365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: