Healthcare Provider Details

I. General information

NPI: 1568953081
Provider Name (Legal Business Name): ELIZABETH MARIE ORVIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 RAE DR
WESTLAND MI
48185-1526
US

IV. Provider business mailing address

8315 RAE DR
WESTLAND MI
48185-1526
US

V. Phone/Fax

Practice location:
  • Phone: 734-716-3842
  • Fax:
Mailing address:
  • Phone: 734-716-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32395
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-38916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: