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General NPI Number Information
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NPI Number | 1619457603
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Entity Type | Individual
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Provider Name | DIVYA SHRIVASTAVA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2018
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Last Update Date | 08/19/2018
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Provider Practice Location Address
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Address Line | 24500 MEADOWBROOK RD
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City | NOVI
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State | MI
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Zip | 48375-2844
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Country | US
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Telephone | 248-477-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 31204 KINGSWOOD BLVD
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City | NOVI
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State | MI
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Zip | 48377-1624
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Country | US
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Telephone | 248-924-7255
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201007279
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License Number State | MI
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