Healthcare Provider Details

I. General information

NPI: 1104018506
Provider Name (Legal Business Name): ROSLYN THOMAS CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30901 PALMER RD
WESTLAND MI
48186-9529
US

IV. Provider business mailing address

628 BLOOMFIELD AVE
PONTIAC MI
48341-2714
US

V. Phone/Fax

Practice location:
  • Phone: 734-367-8504
  • Fax: 734-722-9524
Mailing address:
  • Phone: 248-334-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number23878
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: