Healthcare Provider Details

I. General information

NPI: 1265576730
Provider Name (Legal Business Name): AVA MARIA BELL C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W ANN ARBOR TRL SUITE 200
PLYMOUTH MI
48170-1631
US

IV. Provider business mailing address

18154 SAN ROSA BLVD
LATHRUP VILLAGE MI
48076-2632
US

V. Phone/Fax

Practice location:
  • Phone: 734-414-7056
  • Fax: 734-414-9925
Mailing address:
  • Phone: 248-443-0887
  • Fax: 248-443-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberAA586776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: