Healthcare Provider Details

I. General information

NPI: 1073893152
Provider Name (Legal Business Name): OPTIMAL SPEECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 SNEAD DR
TROY MI
48085-3316
US

IV. Provider business mailing address

1079 SNEAD DR
TROY MI
48085-3316
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-1622
  • Fax:
Mailing address:
  • Phone: 248-879-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAKIKO MIYATANI
Title or Position: PRESIDENT
Credential: M.A., CCC-SLP
Phone: 248-879-1622