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General NPI Number Information
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NPI Number | 1508915505
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Entity Type | Individual
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Provider Name | STARR REBECCA CARUTHERS C.T.R.S.
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15000 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48205-1973
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Country | US
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Telephone | 313-245-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 22022 SHARKEY ST
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City | CLINTON TWP
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State | MI
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Zip | 48035-3664
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Country | US
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Telephone | 586-648-8200
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 53614
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License Number State | MI
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