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General NPI Number Information
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NPI Number | 1528876372
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION THERAPY GROUP
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 22511 TELEGRAPH RD STE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4190
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Country | US
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Telephone | 313-583-7639
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Fax |
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Provider Business Mailing Address
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Address Line | 16925 MASONIC UNIT 124
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City | FRASER
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State | MI
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Zip | 48026-7807
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Country | US
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Telephone | 313-583-7639
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | DESTINY MICHELLE THOMAS
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Credential | OTR/L
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Telephone | 269-532-9505
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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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 | 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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