Healthcare Provider Details

I. General information

NPI: 1447085030
Provider Name (Legal Business Name): CARISSA LEANNE HEESTAND OTD, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44225 W 12 MILE RD STE C-106
NOVI MI
48377-2640
US

IV. Provider business mailing address

20133 NORTHVILLE PLACE DR APT 3203
NORTHVILLE MI
48167-2964
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax:
Mailing address:
  • Phone: 734-233-4686
  • 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:
Title or Position:
Credential:
Phone: