Healthcare Provider Details

I. General information

NPI: 1114656501
Provider Name (Legal Business Name): NURTURE OCCUPATIONAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39300 W 12 MILE RD STE 105
FARMINGTON HILLS MI
48331-3140
US

IV. Provider business mailing address

39300 W 12 MILE RD STE 105
FARMINGTON HILLS MI
48331-3140
US

V. Phone/Fax

Practice location:
  • Phone: 248-719-7002
  • Fax: 734-468-0160
Mailing address:
  • Phone: 248-719-7002
  • Fax: 734-468-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CANDACE PETERSON
Title or Position: OCCUPATIONAL THERAPIST, OWNER
Credential: MS, OTRL
Phone: 616-308-0719