Healthcare Provider Details

I. General information

NPI: 1407067697
Provider Name (Legal Business Name): TINA MARIE DAY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

960 MERIT ST
WHITE LAKE MI
48386-3841
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9610
  • Fax: 248-684-9611
Mailing address:
  • Phone: 248-431-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201005254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: