=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457642415
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH LINCOLN OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2011
-----------------------------------------------------
Last Update Date | 04/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27240 HAGGERTY RD SUITE E-15
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48331-5716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-488-0350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 COURT ST
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02048-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-339-8389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 1749
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------