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General NPI Number Information
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NPI Number | 1770394181
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Entity Type | Individual
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Provider Name | KALEB ROCHA CTRS
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Gender | Male
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 2800 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-1215
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Country | US
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Telephone | 248-615-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 35545 CLINTON ST
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City | WAYNE
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State | MI
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Zip | 48184-2151
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Country | US
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Telephone | 419-906-9933
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 81326
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License Number State |
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