Healthcare Provider Details

I. General information

NPI: 1225305691
Provider Name (Legal Business Name): ANNE MULRENIN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43239 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1957
US

IV. Provider business mailing address

4633 CORRIANDER DR
STERLING HEIGHTS MI
48314-4044
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-2957
  • Fax: 586-323-0022
Mailing address:
  • Phone: 586-739-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: