=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154031524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DPT HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2022
-----------------------------------------------------
Last Update Date | 11/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6209 W SAGINAW HWY STE A&B
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48917-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-974-4378
-----------------------------------------------------
Fax | 630-515-1536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24014 W RENWICK RD UNIT 206
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60544-8711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-974-4378
-----------------------------------------------------
Fax | 630-515-1536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | CINDY SULLIVAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-974-4378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------