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General NPI Number Information
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NPI Number | 1033771589
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Entity Type | Individual
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Provider Name | VINCENT JAMES TKAC MS OTRL
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Gender | Male
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 23265 NORTHWESTERN HWY STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7707
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Country | US
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Telephone | 248-996-9428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7427
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City | DEARBORN
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State | MI
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Zip | 48121-7427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201010622
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License Number State | MI
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