Healthcare Provider Details

I. General information

NPI: 1962960807
Provider Name (Legal Business Name): ROBIN KOWALCZYK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34505 W 12 MILE RD STE 100
FARMINGTON HILLS MI
48331-3287
US

IV. Provider business mailing address

34505 W 12 MILE RD STE 100
FARMINGTON HILLS MI
48331-3287
US

V. Phone/Fax

Practice location:
  • Phone: 734-343-7500
  • Fax:
Mailing address:
  • Phone: 734-343-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201002556
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: