Healthcare Provider Details

I. General information

NPI: 1518100023
Provider Name (Legal Business Name): DEBORAH ALLEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 MARLWOOD DR
WEST BLOOMFIELD MI
48323-2749
US

IV. Provider business mailing address

4133 MARLWOOD DR
WEST BLOOMFIELD MI
48323-2749
US

V. Phone/Fax

Practice location:
  • Phone: 248-682-6923
  • Fax:
Mailing address:
  • Phone: 248-682-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH ALLEN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR
Phone: 248-682-6923