Healthcare Provider Details

I. General information

NPI: 1376454298
Provider Name (Legal Business Name): MICHELLE LEE CASEY OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LIVERNOIS RD
TROY MI
48098-4777
US

IV. Provider business mailing address

26135 FAIRWOOD DR
CHESTERFIELD MI
48051-3026
US

V. Phone/Fax

Practice location:
  • Phone: 248-823-5096
  • Fax:
Mailing address:
  • Phone: 248-823-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201005261
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: