Healthcare Provider Details

I. General information

NPI: 1063711091
Provider Name (Legal Business Name): AMY EMILY ANSARA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 E 12 MILE RD
MADISON HEIGHTS MI
48071-2651
US

IV. Provider business mailing address

42615 GARFIELD RD
CLINTON TOWNSHIP MI
48038-1653
US

V. Phone/Fax

Practice location:
  • Phone: 248-543-4886
  • Fax: 248-543-0479
Mailing address:
  • Phone: 586-412-2845
  • Fax: 586-412-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: