Healthcare Provider Details

I. General information

NPI: 1235845652
Provider Name (Legal Business Name): MS. MICHELLE L HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29800 HOOVER RD
WARREN MI
48093-8918
US

IV. Provider business mailing address

11717 CANTERBURY DR
WARREN MI
48093-1882
US

V. Phone/Fax

Practice location:
  • Phone: 586-574-3444
  • Fax:
Mailing address:
  • Phone: 586-770-3209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007365
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: