=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508382987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BODYWORKZ AND CO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2017
-----------------------------------------------------
Last Update Date | 08/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2498 S ROCHESTER RD
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-3817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-495-0806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3119 PRIMROSE DR
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-5241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARY NAFSOU
-----------------------------------------------------
Credential | OTR/L, CLT
-----------------------------------------------------
Telephone | 248-495-0806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5201005775
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------