Healthcare Provider Details

I. General information

NPI: 1568113157
Provider Name (Legal Business Name): DEIRDRE LIEDER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 08/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S HILL RD
MILFORD MI
48381-2859
US

IV. Provider business mailing address

1625 S HILL RD
MILFORD MI
48381-2859
US

V. Phone/Fax

Practice location:
  • Phone: 248-716-3507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201008462
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number5201008462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: