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General NPI Number Information
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NPI Number | 1962058545
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Entity Type | Organization
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Legal Business Name | LIFE CYCLES THERAPY AND ENRICHMENT CENTER PLLC
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Dates
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Enumeration Date | 08/10/2019
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 1200 MARTIN LUTHER KING JR BLVD # A
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City | DETROIT
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State | MI
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Zip | 48201-2478
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Country | US
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Telephone | 313-854-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 25999 FRANKLIN POINTE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1567
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Country | US
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Telephone | 313-854-1189
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ADRIENNE RUTHERFORD
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Credential | OTR-L
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Telephone | 313-854-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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