Healthcare Provider Details

I. General information

NPI: 1922542539
Provider Name (Legal Business Name): FUNCTION REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 COPPER RIDGE DR STE 202
TRAVERSE CITY MI
49684-6721
US

IV. Provider business mailing address

4110 COPPER RIDGE DR STE 202
TRAVERSE CITY MI
49684-6721
US

V. Phone/Fax

Practice location:
  • Phone: 231-486-6138
  • Fax: 231-486-6140
Mailing address:
  • Phone: 231-486-6138
  • Fax: 231-486-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007563
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ALBRIGHT
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 231-421-9201