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General NPI Number Information
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NPI Number | 1700216975
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Entity Type | Individual
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Provider Name | JEFFREY WILBUR OTL, CSCS
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Gender | Male
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 28555 ORCHARD LAKE RD SUITE #106
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2973
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Country | US
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Telephone | 248-788-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 43889 RIVERGATE DR
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City | CLINTON TWP
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State | MI
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Zip | 48038-1361
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Country | US
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Telephone | 586-822-8209
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 5201004147
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License Number State | MI
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