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General NPI Number Information
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NPI Number | 1790926129
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Entity Type | Individual
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Provider Name | LORI ANN HYDE O.T.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2009
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Last Update Date | 03/14/2009
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Provider Practice Location Address
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Address Line | 35746 HARPER AVE
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-3212
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Country | US
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Telephone | 586-791-9203
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Fax |
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Provider Business Mailing Address
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Address Line | 22524 TROMBLY ST
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City | ST CLR SHORES
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State | MI
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Zip | 48080-2886
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Country | US
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Telephone | 586-778-3649
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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 | 5201003121
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License Number State | MI
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