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General NPI Number Information
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NPI Number | 1952605685
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Entity Type | Organization
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Legal Business Name | OTR REHABILITATION, LCC
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 22172 TWYCKINGHAM WAY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-4709
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Country | US
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Telephone | 248-355-3644
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Fax | 248-355-3644
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Provider Business Mailing Address
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Address Line | 22172 TWYCKINGHAM WAY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-4709
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Country | US
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Telephone | 248-355-3644
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Fax | 248-355-3644
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GREGORY ELLIS RATCHFORD
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Credential | O.T.R.
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Telephone | 248-355-3644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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