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General NPI Number Information
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NPI Number | 1093835043
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Entity Type | Individual
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Provider Name | HARUMBEE FOWLER JACKSON OTR
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4571 W OUTER DR 29510 7 MILE RD, LIVONIA, MI 48152
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City | DETROIT
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State | MI
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Zip | 48235-1223
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Country | US
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Telephone | 313-342-3064
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Fax | 313-345-9906
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Provider Business Mailing Address
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Address Line | 4571 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-1223
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Country | US
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Telephone | 313-342-3064
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Fax | 313-345-9906
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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 | 5201005629
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License Number State |
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