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General NPI Number Information
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NPI Number | 1528655826
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Entity Type | Organization
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Legal Business Name | MINI MITTEN PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 7447 N TELEGRAPH RD
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City | MONROE
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State | MI
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Zip | 48162-9328
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Country | US
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Telephone | 734-888-6464
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Fax | 734-275-0985
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Provider Business Mailing Address
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Address Line | 7447 N TELEGRAPH RD
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City | MONROE
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State | MI
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Zip | 48162-9328
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Country | US
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Telephone | 734-888-6464
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Fax | 734-275-0985
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Authorized Official
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Title or Position | OWNER
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Name | CASEY BROSS
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Credential | OTD, OTRL, CLT, CLC
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Telephone | 734-888-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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