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General NPI Number Information
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NPI Number | 1386708295
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Entity Type | Individual
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Provider Name | ARCHANA SHIRISHKAR OTR
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 26699 W 12 MILE RD STE 202
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1578
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Country | US
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Telephone | 242-353-3260
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Fax | 248-353-3275
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Provider Business Mailing Address
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Address Line | 38004 FRINGE DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-3053
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Country | US
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Telephone | 248-353-3260
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Fax | 248-353-3275
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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 | 5201001865
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License Number State | MI
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