Healthcare Provider Details

I. General information

NPI: 1528876372
Provider Name (Legal Business Name): TRANSFORMATION THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22511 TELEGRAPH RD STE 120
SOUTHFIELD MI
48033-4190
US

IV. Provider business mailing address

16925 MASONIC UNIT 124
FRASER MI
48026-7807
US

V. Phone/Fax

Practice location:
  • Phone: 313-583-7639
  • Fax:
Mailing address:
  • Phone: 313-583-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DESTINY MICHELLE THOMAS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 269-532-9505