Healthcare Provider Details

I. General information

NPI: 1033296496
Provider Name (Legal Business Name): SANDRA ARETHA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA HERTEL

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26025 LAHSER RD
SOUTHFIELD MI
48033-2606
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 248-663-2192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201002993
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: