Healthcare Provider Details

I. General information

NPI: 1356842678
Provider Name (Legal Business Name): MELISSA MAY LABADIE OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W RUSSELL ST
SALINE MI
48176-1184
US

IV. Provider business mailing address

7171 DEERTRACK DR
YPSILANTI MI
48197-9594
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-9401
  • Fax:
Mailing address:
  • Phone: 734-255-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201006761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: