Healthcare Provider Details

I. General information

NPI: 1396205415
Provider Name (Legal Business Name): ANGELA KEJBOU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 03/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 STEPHENSON HWY
TROY MI
48083-2169
US

IV. Provider business mailing address

698 ROBINSON DR
ROCHESTER HILLS MI
48307-4293
US

V. Phone/Fax

Practice location:
  • Phone: 248-327-6619
  • Fax:
Mailing address:
  • Phone: 586-859-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: