Healthcare Provider Details

I. General information

NPI: 1083925937
Provider Name (Legal Business Name): SUSIE YIM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 LIVERNOIS RD SUITE 101
TROY MI
48083-1603
US

IV. Provider business mailing address

5307 TWIN OAKS DR
STERLING HEIGHTS MI
48314-3158
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-0360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5201007751
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: