Healthcare Provider Details

I. General information

NPI: 1720296064
Provider Name (Legal Business Name): PAMELA COFIELD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2685 BROOKLYN DR
YPSILANTI MI
48198-1027
US

V. Phone/Fax

Practice location:
  • Phone: 734-414-7056
  • Fax: 734-414-9925
Mailing address:
  • Phone: 734-484-3726
  • Fax: 734-484-3726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201001981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: