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General NPI Number Information
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NPI Number | 1043548605
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Entity Type | Organization
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Legal Business Name | LISA HURST,COTA,LLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 7377 DEERTRACK CT
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City | YPSILANTI
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State | MI
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Zip | 48197-9591
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Country | US
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Telephone | 734-834-4216
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Fax |
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Provider Business Mailing Address
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Address Line | 7377 DEERTRACK CT
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City | YPSILANTI
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State | MI
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Zip | 48197-9591
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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 | OCCUPATIONAL THERAPY ASSISTANT
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Name | MS. LISA L HURST
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Credential | COTA
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Telephone | 734-834-4216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5202006537
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License Number State | MI
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