Healthcare Provider Details

I. General information

NPI: 1326532995
Provider Name (Legal Business Name): STANLEY T OKOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35100 ANN ARBOR TRL
LIVONIA MI
48150-3543
US

IV. Provider business mailing address

37470 EAGLE DR
LIVONIA MI
48150-5055
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-1444
  • Fax: 734-522-4690
Mailing address:
  • Phone: 313-412-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007533
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: