Healthcare Provider Details

I. General information

NPI: 1699070656
Provider Name (Legal Business Name): JENNIFER NEUHALFEN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CORNELL RD
YPSILANTI MI
48197-1657
US

IV. Provider business mailing address

1055 CORNELL STREET AUTISM COLLABORATIVE CENTER
YPSILANTI MI
48197
US

V. Phone/Fax

Practice location:
  • Phone: 734-485-2890
  • Fax: 734-485-2892
Mailing address:
  • Phone: 734-485-2890
  • Fax: 734-485-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007556
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: