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General NPI Number Information
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NPI Number | 1659104115
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Entity Type | Organization
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Legal Business Name | CHILDRENS THERAPY SHOP
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 24410 MIDDLEBELT RD.
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City | NEW BOSTON
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State | MI
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Zip | 48164-9487
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Country | US
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Telephone | 734-252-9167
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Fax | 734-252-9958
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Provider Business Mailing Address
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Address Line | 24410 MIDDLEBELT RD
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City | NEW BOSTON
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State | MI
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Zip | 48164-9487
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Country | US
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Telephone | 734-664-8180
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | KERIELLE LINNE SMITH
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Credential | OTR/L, MS, MA
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Telephone | 734-252-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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