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General NPI Number Information
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NPI Number | 1891933503
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Entity Type | Organization
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Legal Business Name | GREAT LAKES NEURO-REHABILITATION SERVICES
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 2237 WESTERN MEADOWS DR
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City | FLUSHING
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State | MI
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Zip | 48433-9412
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Country | US
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Telephone | 810-625-0785
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Fax |
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Provider Business Mailing Address
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Address Line | 2237 WESTERN MEADOWS DR
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City | FLUSHING
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State | MI
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Zip | 48433-9412
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Country | US
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Telephone | 810-625-0785
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GAY JANEL LANDENBERG
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Credential | MOT, OTR
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Telephone | 810-625-0785
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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 | 5201004988
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License Number State | MI
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