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General NPI Number Information
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NPI Number | 1164638839
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC CONCEPTS, LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 586 BAGLEY ST
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City | LAKE ORION
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State | MI
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Zip | 48362-3361
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Country | US
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Telephone | 313-790-8421
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Fax |
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Provider Business Mailing Address
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Address Line | 586 BAGLEY ST
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City | LAKE ORION
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State | MI
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Zip | 48362-3361
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Country | US
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Telephone | 313-790-8421
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Fax |
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Authorized Official
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Title or Position | RECREATIONAL THERAPIST
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Name | MS. MICHELE LINETTE LYNK
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Credential | CTRS
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Telephone | 313-717-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24244
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License Number State | MI
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