Healthcare Provider Details

I. General information

NPI: 1669965075
Provider Name (Legal Business Name): JEAN CAREY REMILLET OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MACK AVE
DETROIT MI
48201-2417
US

IV. Provider business mailing address

891 LINCOLN RD
GROSSE POINTE MI
48230-1289
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-8309
  • Fax: 313-745-1174
Mailing address:
  • Phone: 313-404-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number5201001328
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: