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General NPI Number Information
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NPI Number | 1205337474
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Entity Type | Individual
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Provider Name | LENA PAS OTR
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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 | 33875 KIELY DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-3604
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Country | US
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Telephone | 586-716-7398
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Fax |
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Provider Business Mailing Address
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Address Line | 38111 ROCKHILL ST
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1771
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Country | US
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Telephone | 586-489-1474
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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 |
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License Number State |
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