Healthcare Provider Details

I. General information

NPI: 1770324154
Provider Name (Legal Business Name): BEVERLY EILEEN CANFIELD CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7794 PAINT CREEK DR
YPSILANTI MI
48197-6139
US

IV. Provider business mailing address

1669 CRESTVIEW DR
CANTON MI
48188-2042
US

V. Phone/Fax

Practice location:
  • Phone: 734-352-3543
  • Fax:
Mailing address:
  • Phone: 734-564-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number68199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: