MEDICARE: CHONA RAGUERO OTA

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
1	224Z00000X	Occupational Therapy Assistant	5202007669	MI

General Provider Information

NPI Number	:	1134074123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHONA RAGUERO OTA

Provider Business Mailing Address
First Line	:	55520 CRANBERRY DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-1837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55520 CRANBERRY DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-1837
Country	:	US
Telephone Number	:	248-376-5351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ CHONA RAGUERO OTA” Practice Location

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