Healthcare Provider Details

I. General information

NPI: 1609379338
Provider Name (Legal Business Name): LISA JO SCHLICKER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OUTER DR
DETROIT MI
48235-3461
US

IV. Provider business mailing address

20437 LICHFIELD RD
DETROIT MI
48221-1331
US

V. Phone/Fax

Practice location:
  • Phone: 313-585-4820
  • Fax:
Mailing address:
  • Phone: 313-585-4820
  • Fax: 313-543-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201004209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: