Healthcare Provider Details

I. General information

NPI: 1265833925
Provider Name (Legal Business Name): EMILY KRISTEN PAUL OTD, MOT, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LADD RD BLDG D
WALLED LAKE MI
48390-3019
US

IV. Provider business mailing address

3475 PLYMOUTH RD
ANN ARBOR MI
48105-2550
US

V. Phone/Fax

Practice location:
  • Phone: 248-974-1326
  • Fax:
Mailing address:
  • Phone: 734-995-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201008909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: