MEDICARE: MADELINE JOY WELCH 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
1	225X00000X	Occupational Therapist	5201012834	MI

General Provider Information

NPI Number	:	1235843210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE JOY WELCH OTRL

Provider Business Mailing Address
First Line	:	4851 E PICKARD ST STE 2600
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-775-1662
Fax Number	:	989-775-1604

Provider Business Practice Location Address
First Line	:	4851 E PICKARD ST STE 2600
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-775-1662
Fax Number	:

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

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	01/13/2023

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