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General NPI Number Information
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NPI Number | 1871696047
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Entity Type | Organization
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Legal Business Name | MACOMB OAKLAND REGIONAL CENTER INC.
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 15600 19 MILE RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-3502
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Country | US
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Telephone | 586-263-8700
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Fax | 586-412-7889
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Provider Business Mailing Address
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Address Line | 2399 E WALTON BLVD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-1955
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Country | US
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Telephone | 248-475-6400
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Fax | 248-475-6402
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. BRENT WIRTH
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Credential |
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Telephone | 248-475-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011192
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502002486
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502002429
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501005388
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License Number State | MI
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