Healthcare Provider Details

I. General information

NPI: 1578832119
Provider Name (Legal Business Name): TYLER SIMPSON MSOTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 S BRADLEYVILLE RD
REESE MI
48757-9216
US

IV. Provider business mailing address

1636 S BRADLEYVILLE RD
REESE MI
48757-9216
US

V. Phone/Fax

Practice location:
  • Phone: 989-482-0145
  • Fax:
Mailing address:
  • Phone: 989-482-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007900
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: