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General NPI Number Information
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NPI Number | 1104548379
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Entity Type | Organization
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Legal Business Name | ULTIMATE POTENTIAL THERAPY
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 5472 WHISPERING PNES
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9674
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Country | US
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Telephone | 216-409-0239
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Fax |
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Provider Business Mailing Address
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Address Line | 5472 WHISPERING PNES
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9674
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Country | US
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Telephone | 216-409-0239
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | JESSICA BRICKMAN
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Credential | M.S. CCC-SLP
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Telephone | 216-409-0239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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