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General NPI Number Information
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NPI Number | 1437999257
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Entity Type | Organization
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Legal Business Name | CANTON BCC LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 39453 FORD RD
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City | CANTON
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State | MI
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Zip | 48187-4320
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Country | US
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Telephone | 248-277-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 44225 W 12 MILE RD STE C-106
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City | NOVI
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State | MI
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Zip | 48377-2640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO & FOUNDER
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Name | ZIAD KOZA
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Credential |
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Telephone | 248-277-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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