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General NPI Number Information
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NPI Number | 1700099413
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Entity Type | Individual
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Provider Name | CHARETTE LEIGH GOLDA O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2636 S MILFORD RD
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City | HIGHLAND
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State | MI
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Zip | 48357-4938
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Country | US
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Telephone | 248-684-3610
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Fax | 248-684-9611
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Provider Business Mailing Address
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Address Line | 628 DENALI VALLEY DR
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City | MILFORD
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State | MI
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Zip | 48381-1060
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Country | US
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Telephone | 248-787-1402
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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 | 5201002184
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License Number State | MI
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