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General NPI Number Information
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NPI Number | 1942558846
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Entity Type | Individual
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Provider Name | SHAQUEALA HOLLY
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 18285 E 10 MILE RD SUITE. 100
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City | ROSEVILLE
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State | MI
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Zip | 48066-5802
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Country | US
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Telephone | 586-774-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 BANTRY DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1531
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Country | US
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Telephone | 313-778-5844
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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 | 5201007660
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License Number State | MI
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