Healthcare Provider Details

I. General information

NPI: 1639719321
Provider Name (Legal Business Name): JODI RACHELLE LEIB MA, RDT, CDP, CATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODI LEIB CODEN MA, RDT, CDP, CATP

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD STE 780
TROY MI
48084-4745
US

IV. Provider business mailing address

6725 DALY RD UNIT 251952
WEST BLOOMFIELD MI
48325-3280
US

V. Phone/Fax

Practice location:
  • Phone: 248-880-6600
  • Fax: 248-817-8458
Mailing address:
  • Phone: 248-872-1101
  • Fax: 248-671-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: