Healthcare Provider Details

I. General information

NPI: 1750546651
Provider Name (Legal Business Name): MARI NAFSOU OTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY NAFSOU OTR/L, CLT

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2022
Certification Date:
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
48307-7955
US

V. Phone/Fax

Practice location:
  • Phone: 248-495-0806
  • Fax: 248-212-0143
Mailing address:
  • Phone: 248-495-0806
  • Fax: 248-212-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number5201005775
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201005775
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: