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NPI Code Detail

MEDICARE: CELESTE JAMES OTRL

MEDICARE:   CELESTE  JAMES  OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201010096MI

General Provider Information

NPI Number : 1063990083
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELESTE JAMES OTRL
Provider Business Mailing Address
First Line : 3579 CEDARCREST CT
Second Line :
City : WASHINGTON
State : MI
Zip : 48094-1116
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30801 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-1732
Country : US
Telephone Number : 586-293-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2018
Last Update Date : 08/01/2018

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Directions to “ CELESTE JAMES OTRL” Practice Location

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