Healthcare Provider Details

I. General information

NPI: 1518397348
Provider Name (Legal Business Name): INNER CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 FARMINGTON RD STE 114
WEST BLOOMFIELD MI
48322-4454
US

IV. Provider business mailing address

6400 FARMINGTON RD STE 114
WEST BLOOMFIELD MI
48322-4454
US

V. Phone/Fax

Practice location:
  • Phone: 248-318-6654
  • Fax: 248-562-3031
Mailing address:
  • Phone: 248-318-6654
  • Fax: 248-562-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE MINTZ
Title or Position: OWNER
Credential: OTR/L
Phone: 248-318-6654