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General NPI Number Information
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NPI Number | 1104327295
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Entity Type | Individual
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Provider Name | PAIGE JENAE SYJUT OTRL, MOT, CBIS
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 25911 MIDDLEBELT RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1402
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Country | US
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Telephone | 248-471-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 1888 SHERLYNN DR
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City | BRIGHTON
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State | MI
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Zip | 48114-9602
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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 | 5201008778
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License Number State | MI
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