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General NPI Number Information
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NPI Number | 1548712243
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Entity Type | Organization
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Legal Business Name | ROYAL OAK PEDIATRIC THERAPIES, LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 419 W BLOOMFIELD AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-2567
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Country | US
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Telephone | 734-972-1292
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Fax |
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Provider Business Mailing Address
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Address Line | 419 W BLOOMFIELD AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-2567
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Country | US
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Telephone | 734-972-1292
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. ADAM RUSSELL HALL
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Credential |
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Telephone | 734-972-1292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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