Healthcare Provider Details

I. General information

NPI: 1962647313
Provider Name (Legal Business Name): OP THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24301 TELEGRAPH RD
SOUTHFIELD MI
48033-3012
US

IV. Provider business mailing address

24301 TELEGRAPH RD
SOUTHFIELD MI
48033-3012
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-3005
  • Fax: 248-356-9297
Mailing address:
  • Phone: 800-950-3005
  • Fax: 248-356-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN COOKE
Title or Position: PRESIDENT
Credential:
Phone: 800-950-3005