Healthcare Provider Details

I. General information

NPI: 1063913374
Provider Name (Legal Business Name): JENNA LYNN TOLMIE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 WATERLOO ST
GROSSE POINTE MI
48230-1201
US

IV. Provider business mailing address

12722 MASON PLACE
TECUMSEH ONTARIO
815
CA

V. Phone/Fax

Practice location:
  • Phone: 313-473-4730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201008916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: