Healthcare Provider Details

I. General information

NPI: 1295557684
Provider Name (Legal Business Name): EMILY GRACE SCHWALM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MACK AVE
DETROIT MI
48201-2495
US

IV. Provider business mailing address

9332 TEXAS ST
LIVONIA MI
48150
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-8309
  • Fax:
Mailing address:
  • Phone: 734-679-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: