Healthcare Provider Details

I. General information

NPI: 1104327352
Provider Name (Legal Business Name): MEGHAN ELIDA BROOKS MOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 W BRISTOL RD
FLINT MI
48507-3170
US

IV. Provider business mailing address

4466 W BRISTOL RD
FLINT MI
48507-3170
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-2029
  • Fax:
Mailing address:
  • Phone: 810-733-1200
  • Fax: 810-733-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009645
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: