Healthcare Provider Details

I. General information

NPI: 1972276194
Provider Name (Legal Business Name): JANINEH PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2498 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3817
US

IV. Provider business mailing address

2498 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3817
US

V. Phone/Fax

Practice location:
  • Phone: 248-212-0116
  • Fax:
Mailing address:
  • Phone: 248-212-0116
  • 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: MS. EMILY WATSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTRL
Phone: 810-404-9071