Healthcare Provider Details

I. General information

NPI: 1710852231
Provider Name (Legal Business Name): RACHAEL EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 212
WARREN MI
48093-2547
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 212
WARREN MI
48093-2547
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8890
  • Fax:
Mailing address:
  • Phone: 586-573-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: