Healthcare Provider Details

I. General information

NPI: 1972421204
Provider Name (Legal Business Name): FUNCTIONAL LIVING SOLUTIONS OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 STEFFAS RD
MAYBEE MI
48159-9627
US

IV. Provider business mailing address

9850 STEFFAS RD
MAYBEE MI
48159-9627
US

V. Phone/Fax

Practice location:
  • Phone: 734-735-0633
  • Fax:
Mailing address:
  • Phone: 734-735-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BREANNE SHAMPAINE
Title or Position: OWNER
Credential: OTRL
Phone: 734-735-0633