Healthcare Provider Details

I. General information

NPI: 1194591958
Provider Name (Legal Business Name): CLAIRE THERESE BRONNER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE THERESE RYAN OTR

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37250 5 MILE RD UNIT D-1
LIVONIA MI
48154-1848
US

IV. Provider business mailing address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

V. Phone/Fax

Practice location:
  • Phone: 734-462-3240
  • Fax: 734-462-3831
Mailing address:
  • Phone: 734-462-3240
  • Fax: 734-462-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014204
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number122986
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: