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General NPI Number Information
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NPI Number | 1679227912
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Entity Type | Individual
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Provider Name | ADEL MOHAMED OTRL
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Gender | Male
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 2295 E VERNOR HWY
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City | DETROIT
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State | MI
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Zip | 48207-3308
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Country | US
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Telephone | 313-923-5816
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Fax |
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Provider Business Mailing Address
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Address Line | 2236 BELMONT ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3288
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Country | US
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Telephone | 313-858-8885
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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 | 5201012741
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License Number State | MI
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