Healthcare Provider Details

I. General information

NPI: 1497271647
Provider Name (Legal Business Name): VICTORIA JOANNE SEAL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2017
Last Update Date: 08/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 HOWELL ST
PINCKNEY MI
48169
US

IV. Provider business mailing address

3554 RUSH LAKE RD
PINCKNEY MI
48169-8535
US

V. Phone/Fax

Practice location:
  • Phone: 734-954-6700
  • Fax:
Mailing address:
  • Phone: 313-408-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201003153
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: